P - 78750REQUEST FOR ELECTRICAL INSPECTION
1 3 6 4 6 � 7 Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
m (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identity the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION
GENERAL F
SERVICES I POWER SUPPLIES
401 to 800 Ampere �
Above 800 Ampere �
�UITS / FEEDERS
0 to 200 Ampere � $
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
.TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Center Pivot Irrigation Boom (� $
Manufactured Home Park Lots �
� $30 oer Hour
9
C
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for S� ns / Outline Li hti �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senrice andlor Power Suppty up to 500 Amperes, All
Circuits and Two InspecGon Trips Each Dwelli Unit �$8f
Additbnal Insoection Trips � $20
FOR OFFICE USE ONLY
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Request Date: Rough-in inspecdon Required? ❑ Yes ❑ No
totai fee is $20) � ►
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that I insoected the electr�al installatiion
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Ready
� � You must call the inspector when readyt � Date Ready: �
i�rtiy that I am the ❑ LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ri�e electrical wo�C at