P - 80443REQUEST FOR ELECTRICAL INSPECTION
1� 1 U� C� - 5 6 8 � Minnesota Board of Electricity
��
��°�, 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0$00 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identify the work covered by this request: �� 2 _ t r'p j� p / a, �� �j- v` �,(�
❑ NEW O REMODEL O ADDITION REPAIR � f�j � ��- �( f�-FI �► V Yj (.� ('1
GENERAL FE
SERVICES / POWER SUPPUES
0 to 400 Ampere �$25 o i
401 to 800 Am re �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.50
L
Retrofit � $.25 cer Fature
�
F7
Su lemental Fee (� $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
I�cludes the Senrice andlor Power Supply up to 5� Amperes, Ali
Circuits and Two Ins ectlon Trips Each Dwellin Unit �$Bf
Additional Inspection Trips � $20
Investiaative Fee
total fee is
that I insoected the eiechical insiatlation described herein on tlie dates
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IFI��T COMPIETED WITHIN 18 MONTIiS _
FOR OFFlCE USE ONLY
Ilill I I� L/
1 i�ll llll Ilt Illl� ll II �IIl1 IIIII �Illl If i II� G^�'
� 1 1 D B 5 6 B 5� ����-3 T/`w
Request Date: I _ Rough-in Inspection Required? ❑ Yes ❑ No Inspection OTher Than Rough-In: ❑ Ready Now ❑ Will Call �
��� O You must calt the irispecror when ready! Date Ready:
I certify tbat I am the �J LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ai