P - 77414REQUEST FOR ELECTRICAL I��hT�N � -)��
1 3 4y7 5 3 9 Minnesota Board of Electriciry v CJd
+�" � 1821 University Avenue Suite S-128, Sai�Paul, Minnesota 551
(651) 642-0800 TfY/MRS 1-800-627-3529 - _
www. electricity. state. mn. us
Identify the work covered by this request: ry� /w/►� C � Q�� Q C R
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❑ NEW ❑ REMODEL ❑ ADDITION REPAIR
GENERAL FE S Outdoor LiahGna Standard �$t ..�.. ./
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am re � $75
CIRCUITS / FEEDERS
0 to 200 Am re�$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units (� $50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
rate Bondin In 'on � $20
S 'al Ins �on � $30 r Hour
S 'al Ins 'on � $.31 r Mile
_ THIS INSTALLATION MAY BE ORDEREC
Traffic Si nal Standard �$5 U Il.�' '
Su lemenial Fee � $20
Transfortners u to 10 KVA �$10
Transiormers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li hti �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspeclion Trips Each Dwellin Unit �$8(
Additional Inspection Trips � $20
Investiaative Fee
FOR OFFICE USE ONLY
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total fee is
thatlinspected the electricalinstalladon described herein on the dates stated: I
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WITHIN.38�NIONTHS
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I certify that I am the�] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route o.) r Ciy Zip Code
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Section Township Ranae Fire No. Coun
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Power Supplier Address
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lectrical Contrador / Com Name Con
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Mai' g Address (Contractor, Company or Owner Performi Installation)
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Auth�zed Signature (Contract , m Ar Owner Perfortning Installatlon)
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BOARD OF ELECTRICITY COPY
Master License Number
3 �' � � �� �' �� I
INSTRUCTIONS ON BACK OF YELLOW COPY