P - 79294REQUEST FOR ELECTRICAL INSPECTION
�� 1 f�- 5 4 7 � Minnesota Board of Electricity -
1821 Urtiversity Avertue Suite S-128, Saint Paul, Minnesota 55104
. (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
f] NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work cove2d by this request:
?�CEL ENERGY SAV�!?'S SW;TCH
0 to 400 Ampere @ $25
401 to 600 Ampere @ $50
Above 800 Ampere @ $75
;UITS I FEEDERS
0 to 200 Ampere @ $5
Above 200 Ampere @$10
ZM, COMMUNICATION, REMOTE CONTROL, SIGNP
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS 70 7HE GENERAL FEES
iIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units Q$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Ughting Rehofit @ $.25 per Fixture
Center Pivot Irci ation Boom $40
Manufactured Home Park Lots @ $25 �
Recrea6onal Vehicle Park Sites @ $5
Separate Bonding Inspec6on �1 S20
5pecial Inspection � $30 per Hour
Special I�spection � $.31 per Mile
S INSTALLATION MAY BE ORDERE
I III) II III II � II IN II IN � III I! �I II � I� III I I�
�,?7354"73
Traffic Sianal Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
TOTAL FEE I
(minimum total fee is $20) $20,50
TNIS MEA FOR 1l1SPELTOR IbE fNY
1 hereby cer6fy that 1 irtspected tlie electrical i�taUa6on described herein on Me dates sWted:
---------- - - --;.� �. �.�r
�P
�.�Q � s�
Request Dele: Rough�n Inspection Required? ❑ Yes �'Pb Inspedion Other Than Rough-In: ❑ ady Now � NNII Call
(j�(2�� l You must call the inspector when ready! Date Ready:
I certify ihat t am the ❑j�ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the elecUical work at:
IN87RUCTONS ON BACK OF YELLOW COPY BOARD aF ELECTRICRV COPV EB-oo007w-ia e.i. zwe