P - 780991�-567-025 �
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❑ NEW REMODEL ❑ ADDITION ❑
S��b CCL
0 l0 400 Am ere E25
401 to 800 Am ere S50
Above 800 Am ere E75
CIRCUITS / FEEDERS
0 to 200 Am e� E5 ur- �
Above 200 Ampere @S10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Appar�us (o� 5.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units � E50 Per Unit
Each Additional Unft @ S25
OTHER ADDITIONAL FEES
Li htin Retrofit E•25 er Fi�Au2
Center Pivot I' aUon Boom y{0
Manufaclured Home Park Lots S2
Recre�onal Vehide Pak Sites S5
ara� Bo�in Ins tion S20
SDea� Inscection � Y30 oer Hour
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 Universify Avenue Suite S-128, Saint Paul. Minnesota 55104
(651)642-OBOO1lY/MRS1-800�27-3529 www.electricity.stale.maus
R Describe -using back oF the white copy 'rf necessary - the wak covered by ihis request:
SOYI ����) �i��' % b O�
Transformers over 10 KVA S 2(1
Transiamer I Power Supply for Signs / Outline Lighting . SS
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes V�e Service andla Pawer Supply up to 500 Amperes, All
Grouils and Two Inspection Trips Each Dwelling Unil @ S80
Fee
TOTAL FEE ��j_
(minimum total fee is $20) ��Dy�
T�ns u� fa+►aaecroa us� orar
I lKreby cerl�y tl�at I inspabd tlie dxbical i�laYon desaibed haeui on tl�e dales st�ed:
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15670250 2U5�'
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ReQu�t Date: Rougt�-i� Inspeclion Requrced7 ❑ Ves Inspec6on Other Th� RougMn: �Ready Now WGI Call
�` a� a�� You must call the inspeda when ready! pe(e Ready.
I cerd(y that I am 1he �UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection a� the electrical work at: