P - 81704. REQUEST FOR ELECTRICAL INSPECTION
�i _ O � � � � � 6 Minnesota B�ard of Electricity '-
� ��' 1821 Universi Avenue Suite 5-128, Saint Paul� Minnesota 55104
��_�� (65i)642-0800 TfY/MRS7-800-627-3529
wtivw. eCectrici ty. state. mn. us
Identify the work covered by this request: /` G// /����� .�� /Q� , / �p
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NEW ❑REMODEL ❑ADDITION ❑ PAIR , �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traftic Si nal Standard �$5
0 to 400 Am ere �$25 Su lementai Fee �$20
401 to 800 Am re�$50 Transformers to 10 KVA (� $10
Above 800 Am ere �$75 Transtormers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner I Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am e�e f� $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin UnR �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20
Each S atem Device or A ratus (� $.50 Inves � ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20
OTHER ADDI'
Retrofit � $25 per Fix
'ivot Irrigation Boorn �
wred Home Park Lots
mal Vehicle Park Sites
Bondirtg Inspection �
nsoection � $30 oer F
I herebv cerl'Av that I insoected the
TMIS INSTALLATION MAY BE ORDERED DfSCONNECTEq"IF'I�i
FOR OFflCE USE ONLY
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total fee is $20)¢V�
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I certi(y that ! am ihe LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job�g�cjre�ss street. Box, e N�o city . ZiP Code
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S�tion Township Range Fire No. Co J /
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Address
Phone
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�n ame Contractor License Number Master License
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Company or Own Perfortni stallation)
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BOARD OF ELEC7RICITV COPY IN37AUCTIONS ON BACK OF YELLOW COPY