P - 80096REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �
1-�3 3 8- 2 2 5� 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYlMRS 1-800-627-3529
< www.electricity.state.mn.us `�'
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPUES ._
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aonaratus �$.50
.TIFAMILY DWELLINGS (PER
3 to 12 Units �$50 Per Unit
Each A�itional Unit � $25
Outdoo� Lighfing Standard d
Traffic Signal Standard � $5
Supplemental Fee � $20
TransfortneB up to 10 KVA C�
Transformers over 10 KVA �
� Transformer / Power Supply for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Inctudes the Service andlor Power Supply up to 500 Amperes, All
CircuRs and Two Inspection Trips Each Dweliin Unit �$8f
Additionallnsnectan Trios � $20
Fee
total fee is
Manufactured Home Park Lots �$25 I hereby certity that I inspected the electrica� installaeon desaibed herein on the daMS stated:
RecreaCronal Vehicle Park Sites '�"�"'" °ATE
Se arate Bondin Ins 'on �
S ecial Ins ection �$30 er Hour FlNALNS°E01 c� °ATE
S 'al fn eclion � $.31 AMie � � ` �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
I C11l�111�11 Iltii �l1�111tf111�EI �1111 IIIll1l111i11 ��
� � �3ezz�4 � i?'� ap�54
Reauest Date: Rouah-in Insoection Reauired? I�l Yes fl No Insoection Other Than Rouah-I Nnw C7 WiU Call
�� Q� U ou must call the inspec[or when ready! Date Ready:
I certify that I am the�CiCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricel work aC