P - 80167REQUEST FOR ELECTRICAL INSPECTION
.r Minnesota Board of Electricity " �
1� 315 -110 � �821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� � e (651) 642-0800 T'TY/MRS 1-800-627-3529
www.electricity.state.mn.us -
Identify the work covered by this request:
❑ NEW ❑ REMODEL OADDITION ❑ REPAIR ( �} ,' /�� ' J✓�y/1 �it.t `?� �
0 to 400 Ampere (� $'
401 to 800 Ampeie �
Above 800 Ampere �
�UITS ( FEEDERS
0 to 200 Ampere � $
Above 200 Amcere �
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Sysiem Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADC
Liahtina Retroffi � $25 oer F
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su plementai Fee � $20
Transformers u to 10 KVA (� $10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li h6n �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circufts and Two Inspection Trips Each Dwellin Unit �$8f
Additional InspecUon Trips � $20
Investiaative Fee
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FOR OFFlCE USE ONLY
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total fee is
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I certity that I am tl�e �,110ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeclion of the eleclrical work at:
E&00001A•13 7/1/2000 BOARD OF ELECTFIICT/ COPY INSTRUC710NS ON BACK OF VELLOW COPY