P - 78711REQUEST FOR �LECTRICAL INSPECTION
� ��� O�� Minnesota Board of Electriciry
�� � �� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 �
www. electricity. state. mn. us
Identify the work covered by this request:
❑NEW ,�@EMODEL ❑ADDITION ❑REPAIR
GENERAL FEES
0 to 400 Ampere � $25
401 ro 800 Ampere � $50
Above 800 Ampere � $75
�UITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIGI
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
ReVOfit � $25 oer Focture
Recreational Vehide Park Sites
Seoarate Bondina Insoectbn (�
C%�
Su lemental Fee � $20
Trensformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su for S' ns / Outline ' htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, Ail
Circuits and Two In on Trips Each Dwellin Unit �$8C
AddiGonal Inspection Trips � $20
Investiaative Fee
��� ��
I herebvi certH that I
� � Special Inspection �$.31 per Mile I I L /'r°
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETEI
POR OFFICE USE ONLY : �
_ � _ __ — -- --- ----- — � /
� �
INII111fllliflflliillllilllllfilliilllNllllllll! � �
�E i Z 3 3 O 4 2 9�E �
Request Date: Rough-in Inspection Required? s ❑ No Inspection Other Than Rough-In:
��J_T l/� You must call the inspector when readyl Date Ready:
b���L 4
total fee is
herein on the detes
��., o � �
I certify that I am the ,�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of Uie electrical work at: