P - 77651REQUEST FOR ELECTRICAL II�SP��IO�a/ f�
Minnesota Board of Electricity �Q Z �
1�� 4 7� 5 4, � & 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-500-627-3529 �i
ww w. electricity. state. mn. us
Identify the work covered by this request:
❑NEW ❑REMODEL eADD ❑RE IR �C' �%iY7a -
ERAL FEES Outdoor Li htl Standard �$1
SERVICES / POWE PPLIES Trattic S' nal Standard �$5
0 to 400 Am re Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re � Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns / Outline Li htin �$5
0 to 200 Am re ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re � Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$Bf
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addfional Ins ion Tri s�$20
Each stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit (� $25 F0fl1N�GT0"'
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 i hereby cer6l
Recreational Vehicle Park Sites �$5 q01GH1N
rate Bondin In ' � $20
S i81 InS @$30 f HOUf Fl""` "u°E°"a
S ial I ' �$.31 r Mile i
THIS INSTALLATION MAY BE ORDERED DISCONNECTI
FOR OPFlCE USE ONLY
I 11IIII Illll illil 141II il�li IICII I(Ili IIIII 111i IIII
�F 1 3 4 7 5 4 7 O�E
I inspec[ed the
total fee is
'%'6"/�- �•.�i
D��
/��/f O�s
I ce�tify that I am the ❑ IICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspection of the electrical work at:
Ctl-WW1X-13 //1/CUIN wwnvvruc�.�nry����.vr� ��w�..w.�v�wvn........... .�.+....w..