P - 79685REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity ' =�
e � 1� 2 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529
� , ��� ���� www.electricity.statemn.us "���'�
Identliy the work covered 6y this request: � ,¢
❑ RaEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
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GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li htin �$5
0 to 260 Ampere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, CQMMUNIGATION, REMOTE GONTROL, SIGNALtNG Circuits and Two Inspection Trips Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri s�$20
Each S stem Device or A aratus �$,50 InvesG aGve Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20
Each Additional Unit �$25 FOF INSPECTOF USE ONLY
OTHER ADDITIONAL FEES
Manufactured Home Park Lots �$25 I hereby cerMy that I ins tl�e elearicai installallon desrxibed berein on a�e
RecreaUonal Vehicle Pa�k Sites �$5 � r.� : P01�""
5 INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT CvMPLETED
FOR OFFICE USE ONLY
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IIN 18 MONTHS
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request insQection of the electrical work at
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BOARD OF ELECTRICRY COPY INS7AUCTIONS ON BACK OF YELLOW COPY