P - 79870REQUEST FOR ELECTRICAL INSPECTION
1 18 9 7 p 7 � Minnesota Board of Electriciry
�� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
������� (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity.state.mn. us
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR � f
GENERAL FEES Outdoor Liahtina Standard ��1
0 to 400 A
401 to 800
Above 800
�UITS I FE
0 to 200 A
Above 200
RM, COMN
�UITS, CIR
Each Svste
� $�
e�
ere � $5
npere � $10
JICATION, REMOTE CONTROL, SIG
IITS OF LESS THAN 50 VOLTS
Device or Apparatus � $.50
DDITIONS TO THE GENERAL FEES
3 to 12 Units f� $50 Per Unit
Each Additional Unit (� $25
OTHER ADDITI01
Liyyhting Ratrofit � $25 per Fixture
Center Pivot Irriaation Boom � �if
� $30 per Hour
� $.31 oer Mile
Traffic Si nal Standard @ $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer I Power Su for Si ns I Outline Li hdn �$5
ONE & 1W0 FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each DwetNn Un'rt �$8f
Add'Rional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
(minimum total fee is $20)
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I he2bvi ce�iN thal I inspected the Nectrical ins�IlaUon descnbed herein on tl1e deies sffited:
FOR OFFICE USE ONLY
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I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at