P - 77509REQUEST FOR ELECTRICAL INSPECTION � �
l� J V"F � 715 � Minnesota Board of Electricity �-, / ;�„
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� 'r (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe - ng the back of the whfle copy 'rf necessary - the w rk covered s r es •
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GENERAL FEES Outdoor Li htin Standard $1
SE VICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere $25 ""b Supplemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Ampere $75 Transfortners over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I Power Su I for S' ns I Outline Li htin $5
0 to 200 Am ere $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two inspection Trips Each Dweiling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irrigation Boom @ $4C
Manufactured Home Park Lots (� $
Spedal Inspection $30 per Hour
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED
I IIII II III II I�i II � II �!� II I�� If II II III � I� I�
L9847151
Fee
TOTALFEE
total fee is $201
Nat I inspected Ne electrical installation descnbed herein on the dates stated:
IF NOT COMPLETED WITHIN 12 I
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"°`�i � Rough-in Inspection Required? ❑Yes ❑ No Inspection Other Than Rough-In: � Ready N�Will Call
You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricalwork at:
INS7RUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPY oo mrv�,..