P - 79541REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity `�
�� 2 b 8� 8'O 6 �� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
• a���' (651) 642-0800 TTY/MRS 1-800-627-3529
` www.electricity.state.mn.us " '
IdentiTy the work covered by this request ,�� �/1
❑NEW ❑REMODEL ❑ADDITION EPAIR
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GENERAL F ES Outdoor Li htin Standard �$1
S RVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere (� $25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am re (� $75 Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns I Outline Li htin �$5
0 to 200 Am ere (� $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Trips �$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20
Each
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 er Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots (� $25 I hereby certify that I inspecled the elecfical
Recrea6onal Vehicle Park Sites �$5 f01GN1N
Se arate Bondi In ion �$20
S ecial Ins ection �$30 er Hour � � "�" "'8°`'C70N •
S ial Ins ection �$.31 er Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED I COMPI
FOR OFFICE USE ONLY
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total fee is
described herein on the dates s�ted:
---�'"2.,� ° z �
1 WITHIN 18 MONTHS
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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, Box, or Rou[e No.) /� City Zip Code
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Sedion ownship Range Fire No. nry
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Phone
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nse Number Master lice�
Address (Contractor, Company or Owner
or
E&OOOOtA•13 7/1/2 BOARD OF ELECTRICT/ COPY INSTNUCTIONS ON BACK OF YELLOW COPY