P - 79553+P REQUEST FOR ELECTRICAL INSPECTION
�� Minnesota Board of Electricity ��"
�— 2 3 2- 6 3 6 v� ,a2, ����ers�� A�e��e S��te 5-,28, Saint Paul, Minnesota 55104
� ds.�� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
identify the work covered by this request: —�,�C �,y � j �� •'� _„ �, C-�„ �� '�!i� : S_ �_.
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NEW ❑ REMODEL ❑ADDITION ❑ REPAIR � f` ' '� � I%,�'( � ' I � �. ' � E
GENERAL FEES Outdoor Li htin Standar �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to S00 Am ere C� $50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS I FEEDERS Transtormer / Power Su I for Si ns / Outline Li htin �$5
� to 200 Am re �$5 , �� ONE & TWO FAMILY DWELLINGS, EACH UN1T
Above 200 Am ere �$10 Includes the Service andlor Power Suppiy up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellina Unit �$80
:UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Anoaratus ��.50
3 to 12 Units �$50 Per Unit
Each Additional Unft � $25
Fee �
Lighting Retrofit � $.25 per Fixture
Center Pivot Irriaation Boom � $4(
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INSTALLATION MAY BE ORDERED DISCONNECTEQ7F NOT
FOR OFFICE USE OWIY
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I certity that I am the
total fee is
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.ETED WITHIN 18
��580
CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ffie electrical work at: