P - 80068REQUEST FOR ELECTRICAL INSPECTION
�3 2 2 0 5 3� 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: � �Q�� �'4cr�v`G�
NEW ❑REMODEL ❑ADDITION ❑REPAIR � %Gv ,''
GENERAL FEES Outdoor Liahtina Standard �$1
Above 800 Ampere �
�UITS / FEEDERS
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fi�Aure
Center Pivot Irri ation Boom �$40
Manufaclured Home Park Lots � $25
Recreational Vehicle Park Sites �$�i L1 �
Sup lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA (� $20
Transformer / Power Sup I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unft �$80
Additional Ins ection Tri s�$20
Investi ative Fee
Reins ection Fee � $20
TOTAL FEE
(minimum total fee is $20)
OH INSPECTOR USE ONLV
I herebv certilv that 1 inspected tl�e eleclrical installatlon desaibed herein on tice
FOR OFFICE USE ONLY
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J 18 MONTHS
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I ce�iiy that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecfical wak ah
Job Address (Street, Box, or Route NoJ City �P �e
ST. .�, �DG\
Section Township Range Fire No. Counryn
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Occupant
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ower Sup lier Address
Elec[rical Contrector / Company Name
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Mailing Address (Contractor, Company or Owner Perfortnin4
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Aut � ature (Contra�Com r er o
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E9-00001 7/1/2000 �
Phone
Contractor �icense Number
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Installation)
ing Installation) �
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BOARD OF ELECTRICITY CAPY
Master License
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