P - 81816REQUEST FOR ELECTRICAL INSPECTION
�j Minnesota Board of Electricity ="�
1� 1 O 2� 9 7 7 � 1821 U�iversity Avenue Suite S-128, Saint Paul, Minnesota 55104
(651j 642-0800 TTY/MRS 1-800-627-3529
� �� � �' "y www.electricity.state.mn.us
Identify the work cavered by this request:
❑NEW EMODEL ❑ADDITION ❑REPAIR
GENERAL FEES
S VICES / POWER SUPPLIES
to 400 Am re �$25 C� 0
401 to 800 Am re �$50
Above 800 Am ere � $75
IRCUITS ( FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A ratus �$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER AD[
Vehi�e Park Sites �
��— ���/ ���
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer I Power Su I for S' ns / Outline Li Min �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspectbn Trips Each Dwelling Unft �$80
Fee �
tOtal fee iS
that I inspected the electrical installation described herein on the dates stated:
� � Special Inspection �$.31 per Mile I I �1`
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLE
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I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby requesl inspecllon of the electricai work at