P - 79799REQUEST FOR ELECTRICAL INSPECTION
� 3 5 0 6 8 8 �� Minnesota Board of Electricity
� 0 1821 University Avenue Suite S-128, Saint P I, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800-627-3529�� � � �
www.electricity.state.mn.us
Identiiy the work covered by this request:
❑NEW REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to S00 Am ere �$50
Above 800 Am ere � $75
IRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am ere (� $10
ALARM, COMMUNICATION, REMOTE CONTROL, S
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEI
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Addiiional Unit � $25
Boom �
Manufactured Home
Recreaiional Vehicle
r I�� � D�J
Su lemental Fee � $20
Transformers u to 10 KVA (� $10
Transformers over 10 KVA � $20
Transiormer / Power Su for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$S(
Fee
total fee is
I herebv certilY that I inspected the elec6icel irxfellatiai described herein an
THIS INSTALLATION MAY BE �RDERED DiSCVnnt� � tu �r nv i �vmr�c � �v ..� � ���. �o �...... �. ��
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FOR OFFICE USE ONLY ��
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Request ate: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
ZO� You must call the inspector when ready! Date Ready:
I certify that I am the� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Strset, BqZc, or Route No.) City � _ Zip Code
Sec[ion Township Range
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EB-OOOOtA-13 7/1/2000 B p0 OF ELEC7AICTl COPY INSTFiUCTIONS ON BACK OF YELLOW COPY