P - 81568��-051-495 � s�
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Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ADDITION
0 to 400 Ampere �
401 to 800 Ampere
Above 800 Ampere
;UITS / FEEDERS
Above 200 Am ere � $t0
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS (PER UNi�
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL
Li Min Retroi'd �$25 r Fixture
Center Pivot Irri ation Boom �
I�nufectured Home Park Lots
nspection � $2S
� $30 oer Hour
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity =°Y �
7821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity. state. mn. us
P�oi�nPG� C, . �..- - - �
Outdoor Li htin Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppiy up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Insoection Trios � $20
Fee
��_� �8'—�%
(minimum total fee is $20) � otC7
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installa6on described I�erein on the dates ststed:
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w,�
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THIS INSTALLATION MAY BE ORDERED DISCOMNECTED IF NOT COMPLETED WfTNIN 78 MON7M5 i I
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�OFFICE USE ONLY �O
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nequest Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: eady Now Q Will Call
— O^ Q� You must catl the inspecfor when readyf Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: