P - 79672:� �°
. 1-069-296 � �
Identity the work coveretl by this request:
❑ NEW �REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to S00 Am ere �$50
Above 800 Am ere � $75
C{RCUITS I FEEDERS
0 to 200 Am ere �$5
Above 2� Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SI
CIRCUfiS, CIRCUtiS OF LESS THAN 50 VOLTS
Each S stem Device or A ratus �$.50
ADDITIONS TO THE GENERAL FE
Lighting RetroM � $25 per Fixture
Center Pivot Irrigation Boom � $4(
Manufactured Home Park Lots � 9
Recreational Vehicle Park Sites �
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electri ci ty. state. mn. us
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Outdoor Li htin Standard � $t
Traffic Si al Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns 1 Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
GNALING Circuits and Two Inspection Trips Each Dwelli Unft �$80
Additional Ins ion Tri s�$20
Investi tive Fee
ES Reinsnection Fee � $20
N�/ ? ,, .,�t,
I herebvi certilv that I insoected the
I I Special Inspection �$.31 per Mile � �
_ THIS INS7ALLATION MAY BE ORDERED DISCONNECTE
FOR OFFlCE USE WiLY
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total fee is
T COMPLETED WITHIN 18 MONTHS
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I certify ihat I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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Job Address (Street, Box, or Route No.) City 7ap Code
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Section Township Range Fire No. County �
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Power Supplier Address
Electrical Contractqr / Company Namer, ` , ^ Contr�do _Lic�nse Number Macter :: nse Numbe^ ^�
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Address (Contractor. Comoanv or
C,ORIQ8f1Y Of �V/(18f
BOARD OF ELECIAIC1rY COPY
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IN8'TFtUCT10N3 ON BACK OF YELLOW COPY