P - 783441-500-031 �
❑ NEW ❑ REMODEL ❑ ADDITION �(}2
: mr1s.��,w.c � :�� rl�{h .•
0 to 400 Ai
401 to 800
CIRCUITS I FEEDERS
0 to 200 Ampere @ $5
� Above 200 Ampere p$10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit � $25
rigation Boom
Home Park Lc
�ehicle Park Si
Hour
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 —
(651) 642-0800 TTY/MRS 1-800-627-3529 �.electricity.state.mn.us
2_ Describe -using the back of the whit py if nec ary - the work covered by this request:
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Siqns I Outline Liph6ng @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Reins tion Fee $20
TOTALFEE �
(minimum total fee is $20) �� --
iH15 AREA FIXt INSPECiOR USE OfIY
I hereby certiry thffi I inspected the electrical inst�laGon described herein on the dates sfa0ed:
1 riI51N51 ALU►TIVN MAY BE vRDERED D15CONNECTED IF NOT COMPLETED WITHIN 12
I I��I �I II� II III II I�� II �II (I ��I I�III II III �� I�
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oi 0. 50
rtequest Rpugh�n Inspection Required? ❑ Yes �No Inspedion Other Than Rough-In: (�Ready Now � Will Call
�`L � Vou must call the inspector when ready! Date Ready:
I certify tliat I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at: