P - 798621=292-256 ��_��
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Identify the work covered hy this request:
❑ NEW REMODEL ❑ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Amoere � $25
�UITS / FEEDERS
0 to 200 Amoere �
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �'^
1821 University Avenue Suite S-128, Saint Paul, Minnesota 551�4
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity.state.mn. us _
�MMUNICATION, REMOTE CONTROL, 51GNALIN
CIRCUITS OF LESS THAN 50 VOLTS
ystem Device or Apnaratus � $.50
Unit (� $25
OTHER ADDITIONAL FEES
Recreational Vehicle Park Sites �
��I_���y C.0 Ov ,v ' C�
Outdoor L' htin Standard � $1
Traffic Si nal Standard � $5
Su lemental Fee (� $2�
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 Supply up to 500 Amperes, All
G Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Ins ction Tri s�$20
Investiaative Fee
totai fee is
296.'�� .
that I ins0ected the electrical insta4lation dascribed herein on tM
j_ .J_Special Inspection �$.31 per Mile � � ( jj '� b" `" `�.
THIS INSTALLATION MAY BE ORDERED DISCONNECTE OT COMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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R uest Date: Raugh-in Inspectiad Required? ❑ Yes No Inspeetion O[her Than Rough-In: ❑ Ready Now • WiN Call
���� �� � You must call the inspec[or whert�aby! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at