P - 79598REQUEST FOR ELECTRICAL INSPECTION
1 � � � � � � � � ° � d Minnesota Board of Electricity �°
l ��a 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� '� (651) 642-0800 TTY/MRS 1-800-627-3529 -
.
www.electricity.state.mn.us '� �
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am re (� $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
OTHER ADDITIONAI FEES
Retroffi � $25 per Fixture
'ivot Irrigation Boom � $40
lured Home Park Lots � $25
mal VehiGe Park Sites � $5
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lementai Fee (� $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su 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 ion Tri s�$20
investiaative Fee
FOR
TNIS INSTALLATION MAY BE ORDERED DISCONNECTE
FOR OFFlCE USE ONLY
i ii�III IIIIi IIIIi Il1N lfill 111111111� 111111111 flif
3E 1 Z 5 3 1 7 3 7�E
Reques at�� Rough-in Inspection Required? ❑ Yes ❑ No �
total fee is
'�� 3
IONTI
����r �'�,sd
� �Oa You must call the inspector when readyl Date Ready: ' �
I certiiy that l am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecUon of the electrical work at
Job Address (Street, oute No.) A• City � n Zip Code �
Occupant
Power supplier
���
, �
E&00001 A-13
0
Phone
`7/_ �i .
fC�IwC. I c�� Lf��
�
�r�wner Performing Installation)
17�
pany or O er Pe mg Installation)
BOAFiD OF ELECTRICITY COPY
Phone
7� -�/
Master License
s -,c� i ��o i
INSTRUCTIONS ON BACK OF YELLOW COPY