P - 80105REQUEST FOR ELECTRICAL INSPECTION
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Minnesota Board of Electricity "�
��� 7 7� 6 5 4, �,. 1821 Universiry 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 PD1� � `
GENERAL FEES Outdoor Lighting Standard �$1 _
0 to 400 Am ere �$1
401 to 800 Am re �
Above 800 Am re �
CIRCUITS / FEEDERS
to 200 Am re (� $�
Above 200 Am re �
ALARM, COMMUNICATI01
�UITS OF LESS THAN 50 VOLTS
n Device or Apparatus � $.50
ADDITIONS TO THE GENERAL FEES
Retrofit � $25 per Fixture
'ivot Irriaation Boom � $4(
Su demental Fee � $20
Transformers u to 10 KVA �$10
Trensformers over 10 KVA � $20
Transfortner / Power Su for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
includes the Service andlor Power Supply up to 500 Amperes, All
Circuds and Two lnspection Trips Each Dwellin Unii (� $B�
Additional Ins ectan Tri s�$20
Investi ative Fee
Reins ection Fee � $20
� �O � TOTAL FEI
(minimum total fee is $20
Ihe electrical installafion
pecial Ins ec6on �$30 r Hour °""�'"""""' �
�ecial Inspection � $.31 per Mile
�HIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NO'
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I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, x, or Route .) CRy Zp Code
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Section Township Range Fire No. County
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Power Supplier
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Company
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E&O�OtA-13 7/1/2000
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Phone
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Address
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CaMractor License Number Master License Number
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Performing Installation)
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BOAHD OF ELECTAICIT/ COPY
3�-7 S3�v'1
INSTRUCTIONS ON BACK OF YELLOW COPY