P - 78513REQUEST FOR ELECTRICAL INSPECTION
1 3 4 7 4 � 6 m Minnesota Board of Electriciry
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529
www. electriciry. state. mn. us
Identity the work covered by this request: ^��/� �� `� �
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❑ NEW ]SLREMODEL ❑ ADDITION ❑ REPAIR
0 to 400 Ampere � $;
40t to 800 Amoere �
� CIRCUITS / FEEDERS
� 0 to 200 Amcere �$5 � K
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device w atus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25 `
OTHER ADDITIONAL
Li htin Retrofit �$25 r Fixture
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots �$25 1
Recrealional Yeh�le Park Sites � $5 `
Seoarate Bondina InsoecGon � $20
Traffic Si nal Standard � $5
Su lemental Fee � $20 �
Transformers u to 10 KVA �$10
Transfomiers over 10 KVA � $20
Transfortner / Power Su I for Si ns / Outline Li htin �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIF
Includes the Service and�or Power Supply up to 500 Amperes, Atl
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Insoectan Tri�s � $20
Fee �
total fee is
I insoected the eledrical ir�tallation described herein on the dates �ated:
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Special Inspection �$.31 per Mile � S D' U7
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MQNTHS
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FOR OFFICE U8E ONLY � \ �/1
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Request Date: Rough-in Inspection Required? ❑ Yes o Inspection Other Than Raugh-In: ❑ Reedy Now ill Call
You must call the inspector when ready! Date Ready:
I rtify t I am the�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec6on oi the electrical work at