P - 77415REQUEST FOR ELECTRICAL_� SPE TIUON�� O n
1 3 4 7 5 2 7 Minnesota Board of Electricity � . 1
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electrici ty. state. mn. u
Identify the work covered by this request: �� ,u e� � p �► � �r `
7
❑ NEW ❑ REMODEL ❑ ADDITION
GENERAL F
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units C� $50 Per Unit
Each Additional Unit � $25
Outdoor Li htin Standard � $1
Traffic Si nal Standard (� $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline ' hti �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Und �$S(
Additional Inspection Trips � $20
Investiaative Fee
total fee is $201� Sa
Li htin Retrofd �$.25 r Fixture
CeMer Pivot I' tion Boom �$40
ManUfaCtul2d HOme Pa�lt Lots �$25 I hereby cer�y that I inspected the electrical installation described herein on ihe dates stated:
Recreational Vehicle Park Sites �$5 101�' "' o"T�
S rate Bo�din In �on � $20
S'al Ins ion �$30 r Hour F'""'s°E°"°" , �„�
S'al In ' n�$.31 r Mile � Z�'`��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN t8 MONTHS
FOR OFFICE USE ONLY
I Illfll 11111 III(I illll IIIII IIIII lill I 1i111 IIII IIII
�E 1 3 4 7 5 c 7 c 3E
R est te: � Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: eady Now ❑ Will Call
` You must call the ins y dy
pector when read ! Date Rea :
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Jo�rQSS (Stree,tf,� x, or Route No.) y City�� � Zip Code
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Section Township Range Fire No. Cou /
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Mailinq Address (Co
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any or Owner Pe rming In tion� �
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o�ipan or Owner Performing Installation)
eo�r+u oF �crA�cm covr
Master License
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