P - 78772RE(�UEST FOR ELECTRICAL INSPECTION
1� 3 4 7 3 2 0 Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
,.....;�'
www electricity state mn us
Identity the work covered by this request:
❑ NEW ODEL ❑ ADDITION ❑ REPAIR U Gci-2�i. �""`� �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re�$25 Su lemental Fee �$20
401 to 800 Am re�$50 Transfortners u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfomrer / Power Su for Si ns / OuNine Li b �$5
0 to 200 Am re�$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNAIING Circuits and Two Inspection Trips Each Dwelli Unit �$8(
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additi�onal Ins ion Tri �$20
Each S em Device or tus �$.50 Investi ative Fee
ADDmONS TO THE GENERAL FEES ReinspecGon Fee �$20
FAMILY DWELLINGS (PER UNIn
to 12 Units �$50 Per Unit
�ch Addi�onal Unit � $25
OTHER ADDITIONAL FEES
ghting Retrofit � $25 per FbAure
anter Pivot Irtigation Boom � $40
anufactured Home Park Lots � $25
ecreational Vehide Park Sites � $5
�parate Bonding Inspection � $20
�ecial Insoection � $30 oer Hour
;�;� ��
I herebvi cerlilv tl�at I
ial Inspection �$.31 per Mile 1 I
ic iucTe� � e'r�AN w1AV RF AR�IFRF1'1 1'fISCANNECTI
num total fee is $20) �/�`
/.OG �( 0
�/A- � !/ L�rf4�
/`� - %- 3 � °�
ion desaibed herein on Cie de�s slated
I certify that I am the ❑ LICENSED CONTHACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at