P - 79876, REQUEST FOR ELECTRICAL INSPECTION
�„v Minnesota Board of Electricity ``�
�� 211- 4 5 9� y� 1821 ����e�s�� A�e��e SU�=e 5-,28, Saint Paul, Minnesota 55104
��� m (651) 642-0800 TTY/MRS 1-800-627-3529 _ '
www.electriciry.state.mn.us ��� %�' � "
Identify the work covered by this request: w ����\� � n t;�. -� �� ��
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❑ NEW ❑ REMODEL ' DDIT40N ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Sup lemental Fee �$20
401 to S00 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA f� $20
CIRCUITS / FEEDERS Transfortner / Power Su I for S' ns / Outline Li hGn �$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 Circuits and Two Inspection Trips Each DweNing Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addftional Ins ection Tri s�$20
Each S stem Device or aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee �$20
MULTIFAMILY DWELLINGS PEA UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum to I f i$
EeCh Add'Rion11 Unit �$25 roa insrECTOn usE ori�v
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Center Pivot Irrigation Boom � $
Manufactured Home Park Lots �
I herebvi cerfilv that I inspected the electrical
�ecial Inspection � $.31 per Mtle � {
'HIS INSTALLATION MAY BE ORDERED DISCONNECTE
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I certdy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at
Job Address (Street, Box, or Route No.) City Zip Code
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Section Township Range Fire No. County
Occupant Phone
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Power Supplier Address
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Electrical Contractor / Company Name
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Mailins7 Address (ConVactor. C
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7/1/2000
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BOARD OF ELEC7HICT/ COPY INSTpUCTONS ON BACK OF YELLOw ^^"'