P - 79785REQUEST FOR ELECTRICAL INSPECTION e�
,1 312 6 31 Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
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www.electricity.state.mn.us
IdentiTy the work covered by this request: �� ��° 3� (� �, — �lpl�. �Y YVq �, • ,
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❑NEW ❑REMODEL ❑ADDITION EPAIR
GENERAL FE S Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
n �n 400 Amoere �$25 Su lemental Fee �$20
200 Ampere � $10
)MMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
�ystem Device or Apparatus � $.50
ADDITIONS TO THE GENERAL F
ILY DWELLINGS (PER UNI�
? Units � $50 Per Unit
�dditional Unit � $25
OTHER ADDITIONAL FEES
a Retrofd � $25 per Fixture
Pivot Irrigation Boom � $40
actured Home Park Lots � $25
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for S� ns / Outline li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$�
Fee �
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�R OFFICE USE ONLY
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total fee is
the electricalinstallatlon described herein onthe dates stated: �
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I certify that t am the [�LICENSED CONTRACTOR ❑ COMPANY �"OWNER and hereby request inspection of the electrical work at
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