P - 785111-347-403 ��
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Itlentiiy the work coveretl'by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
0 to 400 Am re �$;
01 to 800 Am ere �
Above 800 Am ere �
CIRCUITS / FEEDERS
0 to 200 Amcere � S
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
w. electrici ty. state. mn. us
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CIRCUITS OF LESS THAN 50 VOLTS
ystem Device or Apparatus � $.50
ADDITIONS TO THE GENERAL FEES
OTHER ADDITIONAL FEES
Manufactured Home Park Lots �
Recreational Vehicle Park Sftes (�
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Trans(ormers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortner / Power Su I for S' ns / Outline L' htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Indudes tl�e Service arb/or Power Suppty up to 500 Amperes, All
CircuiLs and Two Inspection Trips Each Dwellin Unit ��i8(
AddiGonal Insoection Trios � $20
Fee �
Mat I inspected the
total fee is
� -- m� -wn �er y,s� i nuu� — — �. _-------/ '�—.U�/ . I
Special Inspecbon � $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNE NOT COMPLETED WITHIN 18 MONTHS
Fon oF� usE on�r ,CJ� ���
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�que DaJ�• Rough-in Inspection Required? ❑ Yes ❑ No Inspecdon Other Than Rough-In: ❑ Ready Now � Will Call
S/ � C You must call the inspector when readyl Date Ready:
i certify that i am the ❑ LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at: