P - 78406REQUEST FOR ELECTRICAL INSPECTION
1�� 5 6��� 7 Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
- � �°�� � (651) 642-0800 TTY/MRS 1-500-627-3529
�� www.electricity.state.mn.us .�...� l�� �V ��•
Identi(y the work covered by this request lo U�� n � c� �� �± � !, �� e,� �^
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❑NEW REMODEL ❑ADDITION ❑REPAIR �27 i OC� � �j{%LC.�I I T
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES TraHic Si nal Standard �$5
0 to 400 Am re�$25 Su lemental Fee �$20
401 to 8W Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS � Transformer / Power Su for Si ns / Outline Li hN �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 � Includes the Service andlor Power Suppty up M 500 Amperes, All
ALARM, COMMUNICATION, REMOTE EONTROL, SIGNALING Circuits and Two Inspectlon Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins eclion Tri �$20
Each S stem Device or A ratus �$.50 Investi abve Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20) � "
Each Additional UnR � $25 � �P�T�R � ��
OTHER ADDITIONAL FEES N��°u"'�3
Liahtina Retrofit ��25 cer FBcture &`' �'�'�
CeMer Pivot I' atlon Boom �$40
Manufactured Home Park Lots �$25 i nere ce �
Fiecreational Vehicle Park SBes �$5 101GH1N
Se arate Borniin Ins ecbon �$20
S ial In 'on �$30 r Fbur �►"'�'�"
S ial Ins 'on �$.31 r Mi�e
THIS INSTALLATION MAY BE ORDERED DISCONNECTE[
FOR OFFICE USE ONLY
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I certify that I am the
ected the electrcal installatlon desraibed herein on Ihe date,a staled:
o�re
� �/ DAIE/y
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COMPLETED WITHIN 18 MONTHS
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CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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OF ELECTRICRY COPY
INSTHUCTIONS ON BACK OP YELLOW COPY