P - 81801REQUEST FOR ELECTRICAL INSPECTION
1 � � � � � � � � � � Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� ``���e'� (651) 642-0800 TTY/MRS 1-800-627-3529
: rvww.electricity.state.mn.us
Identify the work covered by this request �,�� �,�
EW ❑REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES Outd�r Li htin Standard �$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere 8$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin '� $5
0 to 200 Am ere �$5 —' ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$70 Includes the Serv+ce and(or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ion Tri Each Dwelli UnR �$80
CIRCUITS, CIRCUI7S OF LESS THAN 50 VOLTS Additional Ins 'on Tri �$20
Each S em Device or A ratus �$.50 tnvesti tive Fee
ADDI710NS TO THE GENERAL FEES Reinspection Fee �$20
ReVOfit � $.25 per Fixtu
�ivOt IRlgation BoOm � $
tured Home Park Lots �
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total fee is $20) �a'�
descn'bed herein ai
S ial In 'on �$30 r Fbur �' i _..._
Snecial Insuection � $ 31 per Mile � � �'— � �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED OT COMPLETED WITHIN 18 MONTH$
FOR OFRICE USE ONLY
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Request bate: Rough-in InspecUon Required? ❑ Yes �o InspeMion Other Than Rough-In: dy Now 0 WiB Cail
�' 3" 0 You must call the inspector when readyl Daie Ready:
I certify that I am the ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricai work ak
Job Address (Street, Box, or Route No.) City Zp Code
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BOMD OF ELEC7AICRY COPY 815TRUCTIONB ON 9ACK OF YELLOW COPY