P - 78862REQUEST FOR ELECTRICAL INSPECTION
1� 3 4 7- 314 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
lentity the work covered by,this request: `� �
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!RE REMODEL DDITION ❑ REPAIR � [ � L� � `
aut to Bo0 Ampere � $50
Above 800 Ampere � $75
�UITS / FEEDERS
0 to 200 Ampere � $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL,
:UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$,Sp
3 to 12 Units �$50 Per Unft
Each Additional U�it � $25
OTHER ADDI
Lighting Refrofit � $25 per Fia
Center Pivot Irrigation Boom �
Manufactured Home Park Lots
Recreafional Vehicle Park SRes
Standard � $5
Fee � $20
up to 10 KVA (�
over 10 KVA �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, qil
Circuits and Two Ins ection Trips Each Dwelli Unit �$B(
Additional Inspection Trips � $20
I Frereby cerMy that I
Fee �
total fee is $20) � S
cribed herein on tl�e de�s �eted:
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� 5 ecial In 'on �$.31 r Mile � 2 S,�'
� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MO S
FOR OFFlCE USE ONLY — �—
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Requ�Da � O� Rough-in Inspection Required? Yes ❑ No Inspection Other Than RougMln: ❑ Ready N Will Call
You must cal� the inspector when readyl Date Ready:
I certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ]�OWNER and herebv reouest insoection of tha ai�r;�i W,�,k �+•
•••....... ..� �� � n��� �� wr� INSTRUCTIONB ON BACK OF YELLOW COPv