P - 82005fi RE(�UEST FOR ELECTRICAL iNSPECT{ON
�J � � � � � �,� Minnesota Board of Electricity
r� 1 � � * 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
2 ° (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identity the work covered by this request:
❑ NEW EMODEL ❑ADDITION ❑ REPAIR � C��1Lj �Sd CaS I��
GENERAL FEES Outdoor Li hGn Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard (� $5
0 to 400 Am ere �$25 Sup 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
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CIRCUITS l FEEDERS Transformer / Power Su I for Si ns / Outline Li hiin (� $5
0 to 200 Am re �$5 i, rr� ONE & TWO FAMILY DWELLiNGS, EACH UNIT
Above 200 Am re �$10 Includes ihe Service and/or Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING C+rcuits and Two {nspection Trips Each Dwellir�g Unit �$8C
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional In ection Tri s�$20
Each S stem Device or ratus �$.50 Investi ative fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
,�„ „,,„;+� �, cs� Po. � �,,,, (minimum total fee is $20'
Fixture
Manufactured Home Park Lots �
Recreational Vehicle Park Sites �
Seoarate Bondina Insoection � $�
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on tha d�s stated:
7-�6"'
18 MONTI
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at