P - 79886.__ REQUEST FOR ELECTRICAL INSPECTION
1� 2 5 5� 7�� �� Minnesota Board of Electricity �°"°
�� � 182i University Avenue Suite S-128, Saint Paul, Minnesota 55104
P�� E° (651) 642-0800 TTY/MRS 1-800-627-3529
www electricity state.mn us
Identify the work covered by this request ��s ��` Q� a� .� � .pti V.�
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR "— � � � � ` �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Ampere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transfortners u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over i0 KVA �$20
CIRCUITS / FEEDERS Transfortner / Power Su for Si ns / OuGine Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circufts and Two Inspection Trips Each Dwellin Unit �$Bf
CIRGUITS, CIRCUITS OF LESS THAN 50 VOL7S Additional Ins ion T' �$20
Each S stem Device or A aratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEI
3 to t2 Units c� $5o Per Unit (minimum total fee is $20
Each Additional Unit �$25 FOR INSPECTOR USE ONLV 2 9� 2 g
OTHER ADDITIONAL FEES
tliat I inspected tl�e
Recreational Vehicle Park SRes
ial In 'on � $.31 r Mile
IS INSTALLATION MAY BE ORDERED DISCONNE
FOR OFFICE USE ONLY �
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herein on the �tes stated:
i certi(y that I am the � LICENSED CONTiiACTOR ❑ COMPANY ❑ OWNER and hereby request inspection di the electriCai work at:
Job Address (Street, Box, or Route No.) City Zp Code
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� Mailing Address
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BOARD OF ELEC7AICITY COPY INS7RUCTIONS ON BACK � YFILOW COPY