P - 81581��� � Lt� � � �(f�ly�iEQUEST FOR ELECTRICAL INSPECTION
�• 0 Minnesota Board of Electricity —"
��� 4���, �, � `�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
` �,s �, (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us ''�'
IdentiTy the work covered by this request: �('� � �/� /
1 .n � � 1 \. ( .I
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR )�.0 r�rLC,�.�-2.- `�" � �
GENERAL F S Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Sup lementai 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 I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & 7W0 FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppty up to 500 Amperes, Ali
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$60
ciar,UITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Trios �$20 _
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL f
.TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units (� $50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per Fi�ure
Center Pivot Irtigation Boom � $40
Manufadured Home Park Lots �� _
Racreational Vehicle Park Sites
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i herebvi certiN that I
FOR OFFlCE USE ONLY
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total fee is
insNallation des�xibed herein on tl�e dates stated:
I certi(y that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (S et, Box, or Route No.) City Z�P �
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Section Township Range Fire No. County
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s��ra� ��� nddresg
cal Contractor / Company Name
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g Address (CoMracS,Qr,_Com any or Qwner PeAortning tnstallation)
Phone �
Number
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or chmer Nertormmg inscananon� ���
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60AAD OF ELECTRICRV COPY INSTRUC710N3 ON BACK OF VELLOW COPY