P - 76068� O � � � � � � REQUEST FOR ELECTRICAL INSPECTION
o � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Describe -using the back of the white copy 'rf necessary - the work covere�i by this request:
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VICES / POWEFYBUPPUES �
0 to 400 Ampere @ $25
401 to 800 Am�re @ $50
Above 800 Am�re @ $75
:URS/FEEDERS
0 ta 200 Ampere @ $5
Above 200 Am�re @$10
�tl, COMMUNICATION, REMOTE CONTROL, SIGI
:URS, CIRCUITS OF LESS THAN 50 VOLTS
Each System bevice or Apparatus @$.50
ADDI170NS TO THE GENERAL FEES
TIFAMILY DINELLINGS (PER UNin
3 to 12 Units Q$50 Per Unit
Each AddfUonal Unit @ $25
OTHER ADDRIONAL FEES
�9�9 �� @ $25 per Fodure
Cerder Pivot Irtiaatlon Banm (a� S40
up to 10 KVA
over 10 KVA �
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ONE & Nd0 FAMILY DWELLINGS, EACH UNIT
Includ� the Service and/or Power Supply up to 500 Amperes, All
Cirarits arid Two InspecUon Trips Each Dwetlmg Unit @$BO
Additionall� 'onT' $20
Investlgative Fee
Reins 'on Fee $2(1
TOTAL FEE
(minimum total fee is $20) � ��
rws a�n r�t u�croR use orb
I hereby cert(fy tl�et I Nspected tire electricel installadon desa�ed hereN on the de0es steted:
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� Rough-In InspecUon Required? ❑Yes ❑ No Inspectlon Ofher Than Rough-In: 0 Ready Npv�p�,iWfll Cell �
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� � You must call the Inspeaor when readyl Date Ready.
I certify thati am th�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electri�l work at