P - 75522REQUEST FOR ELECTRICAL INSPECTION ���'
1s�'"''�� e�, Minnesota Board of Electricity
. '��� ��� � 1g21 Universily Avenue Suite S-128, Saint Paul, Minnesota 55104
s (651) 642-OS00 TTY/MRS 1-800-627-3529 www.electricity.state.mn.tes
Desaibe - sing the back of the ite copy ff necessary - the work covere.d by this requ�t:
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GENERAL F ES Outd�r Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Si naI Startdard @$5
0 to 400 Ampere @$25 plemental F� @$20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transfomrers over 10 KVA $ 20
CI CUITS / FEEDERS Transfortner / Powrer Su I fir SI ns / Outline Li hdn $5
0 to 200 Am re$5 ONE & TWO FAMILY DWEWNGS, EACH UNR
Above 200 Am re $10 Ir�cludes the Service and/or Power Supply up to 5�0 Amperes, All
AL4RM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circwits and Two Inspection Trips Each Dweliing Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 'on Tri $ZO
Each System Device or A @$.50 I ' ative Fee
ADDITIONS TO THE GENERAL FEES Reins on Fee $20
MULTIfAMILY DWELLINGS PER UN TOTAL FEE
3 to 12 units @$5o Per Unit (minim�un total fee is $201 ���
rrt @�.zs per Flxd,re i nereny certry tne� i mspecaea ure eiectr� �uano,� aescnroea nere�n on are aams amcea:
' ation Boom @ $40 �" °Y �+�
Home Pazk Lots $25 .� -( 3^ G''�
�ehlcle Park Sites $5 �^' °'��"0P �T� �
Ins 'on $20 �- ��� �'
�ion @ $30 r Hour O0'�D"�^"m0"�0 ��
�ion @ $.37 per M�e
LATION ANAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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��' Rough-in InspecUon Required9 ❑Y� o Ins
� � � pectlon Other Than Rough-In:
� You must call the inspec4or when readyl pate Ready.
I certiRy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ 0 R and hereby request' pecf
Job 3(te Street Address �
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WSTRUCTIONS ON BACK OF OW COPY
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� Electri I U ty Address
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Contrador License Nurt
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Owrter Performing InsFeOatlon)
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ier eAorminglnstallation) please!
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BOARD OF ELECTRICT' COPV
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mascer rrecmaan or
Licer�se Number
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