P - 80103REQUEST FOR ELECTRICAL INSPECTION
� �� Minnesota Board of Electricity '�
��.� J��-�� 3 ���e e 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�a� a (651)642-0800 TTY/MRS 1-500-627-3529
www.electricity.sta2e.mn.us "�'
Identity the work covered by this request: ����\\� __ �� _\�^ �� j�� r� .`� p
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❑ NEW ❑ REMODEL ADDITION ❑ REPAIR
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 Transtormers u to 10 KVA (� $10
Above S00 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for S' ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additlonal Ins ion Tri �$20
Each S stem Device or ratus �$•50 Investi ative Fee
ADDI710NS TO 7HE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL PEE
s to �2 unas c� $5o Per unit (minimum total fee is $20)
Each Additi0�81 Unit �$25 � i�craa usE a+ir
OTHER ADDITIONAL FEES
Li hti Retrofd �$25 er Fature
Center Pivot I' ation Boom �$40
Manufactured Home Park Lots �$2 ( I hereby certify that I in ed tl�e electrical installatlon described herein on tlie dates stated:
Recreational Vehicle Park Sites �$5 10�" �' �'�
S rate Bondin In ion �$20
S ecial I 'on �$30 r Hour F"i"''"ar�°"°"' Gj ��
S'al Ins ectan �$.31 r Mile /^'� s��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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I certify that I am the (� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at
Job Address (Street, Box, or Route NoJ G ZP �
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Section Township � R i10'�l0. Co� _
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Power Supplier
rical CoMrec[or / Company ame
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Mailing A ss (Contractor�Company o�
Auth Signature (Contractor, C mpany or
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EB-00001A-13 7
Phone \
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nse Number Master License�
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BOARD OF ELECTRICITV COPY
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