P - 81603REQUEST FOR ELECTRICAL INSPECTION
1�3 0 g 3 2 q0 m Minnesota Board of Electricity
� - 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� � (651) 642-0800 TTY/MRS 1-500-627-3529
' www.electricity.state.mn.us " '
Identity the work covered by this request: �,�S,�,s O ,/�.�t/��
❑ NEW ❑ REMODEL ❑ADDITION EPAIR
GENERAL FE S Outdoor Li htin Standard (� $1
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere (� $5
Above 200 Am re (� $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDI710NS TO 7HE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per UnB
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofd �$25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $2
Recreational Vehicle Park Sites � $5
S rate Bondin Ins ection �$20
S ial Ins 'on �$30 r Hour
Soecial Insoection � $.31 per Mile
Traffic Si nai Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li han �$5
ONE & TWO FAMILY DWELIINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$S(
Additional Inspection Trips � $20
Investiaative Fee
I herebvi certily that 1
FOR OFFlCE USE OlILY
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total fee is
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the dates �ated:
I certify that I am the' "LICENE
Job Address (Street, Box, or Route
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Sedion Township
upant
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CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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Range Fre No. County
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Electrical Contractor / Company Name
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Mailing Address (Contredor, Company or Owner Perfortning Installation)
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Aythprized Signature (Contrador, Cop�pany or Owner Perfortning In IIt
Phone r�
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7/1/200D BOARD OF ELECiRICRY COPY
Number
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INSTRUCTIONS ON BACK OF YEILOW COPY