P - 776971 REQUEST FOR ELECTRICAL INSPECTION
1�, 6 4 Z�� 1� � Minnesota Board of Electricity �/�v� daJ("�
1821 University Avenue Suite S-128, SaiM Paul,lGfinnesota 55104 �''`�
(651)642-080011Y/MRS 1-800-627-3529 www.electricity.state.mn.us
O NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Desaibe -using the back of the white copy'rf necessary - the work covered by this request:
0 to 400 Ampere @ S25 / 0 6�
401 to 800 Ampere � E50
Above 800 Ampere � $75
.UITS / FEEDERS
0 to 200 Ampere @ $5
Above 200 Ampere @$10
tM, COMMUNICATION, REMOTE CONTROL
;UITS, GRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL I
fIFAMILY DWELLINGS (PER UNIn
3 to 12 Units �$50 Per Unit
Each Additional Unit @ E25
OTHER ADDITIONAL FEES
Ligh6ng Rehofit � 5.25 per Fixture
Center Pivot Irriaation Boom � S40
I IIII il III II Iil II Ili II III II ill II III II III �� I�I
16411134
� Trmisfortners up to 10 KVA �$10
� Trans(ormers over 10 KVA � S 20
Transfortner I Power SuDdY � Si9ns I Outline Li�hting s5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senice andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Owetling Unit @$BO
Inves6 aative Fee
Reins tion Fee 520
TOTAL FEE
(minimum total fee is $20) �Q, J�±
THSAqEAFORNSPECTORIbEMY
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�� �= Roughin Inspedion Required? ❑ Yes �, No Inspection Olher Than RdigMn: eady Now � WA1 Cail
�� 2 7� � 5 You musl call the inspector when ready! pete Ready;
I cerBfy Ihat I am the �LICENSED CONTRACTOR ❑COMPANY � OWNER and he►eby request inspection of the electrical work at: