P - 79543REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota Board of Electricity `�
� � � � � � � � � ��� �e 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
�"� `°� (651) 642-0800 TTY/MRS 1-8 - 27-3529 -
www.electricity.state.m . s
Identify the work coveretl by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR . `Q � 7
GENERAL FEES Outdoor Liahtina Standard �$1
0 to 400 Ampere � $;
401 to 800 Amoere �
0 to 200 Ampere �
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS IPER UNITI
OTHER ADDITIONAL FEES
Lighting Retroflt � $25 per Fixture
Center Pivot Irti ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park SRes � $5
Su lemental Fee � $20
Transformers up to 10 KVA (� $10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMfLY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Tri s Each Dwellin Unit �$8C
Additional Insoection Trios (� $20
Fee (�
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INSTALLATION MAY BE ORDERED DISCONNECTE
FOR OFFICE USE ONIY
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total fee is
that I insnected the elec[rical installatlon described herein on
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COMPLETED
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I certi(y that I am th LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at