P - 79575REQUEST FOR ELECTRICAL INSPECTION
Q � �� Minnesota Board of Electricity �
�-�2 4 5� J O� �� i821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
e,a��� (651) 642-0800 TTYIMRS 1-800-627-3529
� www.electricity.state.mn.us " '
Identify the work covered by this request:
�tis���.�2�ou,T�rs iu.� a�r�v� � �j
❑ NEW REMODEL ❑ ADDITION � REPAIR GO v� G�-+ �. � G�-� �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above S00 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / 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 re �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ection Trips Each Dwellin Unit �$80
CIRCUITS, CIFCUITS OF LESS THAN 50 VOLTS AddiGonai Ins ion Tri s�$20
Each S stem Device or A aratus �$.50 InvesG tive Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20
Each Additional Unit � $25 '"'"`�""' w` """
OTHER ADDITIONAL FEES
Li htin RetroM �$25 er Fixture
Center Pivot Irri ation Boom �$40
Manufaciured Home Park Lots (� I hereb ce ' N�at I i�
Recreational Vehicle Pa�C Sites "01GH"
Se arate Bondin Ins ection �$20
S ial Ins ection �$30 r Hau FlIUL INSPECPON
S ial Ins ection �$.31 r Mile �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF
FOR OFFICE USE ONIY
I 1llili IIIII II III II11111111 lllll llill illll Illl IIII
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the
total fee is
on tl�e �tes stated: I
l �0��
t MONTHS _
1 certiiy that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tlie electricaF work at:
Job Address (Street, Box, or Route No.) ," ;�' Z�P ��e
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Section Township Range . nty
� Power Supplier
� Authorized
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Ad
pany Name 4
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�r, company o•�—•— r Owrier Perfc
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tractor. Comoanv or Owner
Phone
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nse Number Master License
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�eParl� +EY1�n ��
Phone
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HOAtiD OF ELECTRICITY COPY � IN37AUCTIONB ON BACK OF YELLOW COPY