P - 78990REQUEST FOR ELECTRICAL INSPECTION
������- 6 6 2 0 Minnesota Board of Electricity -
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYIMRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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Standard
0 to 400 Am re $25 Su lemental Fee $20
401 to B00 Am re $50 Transformers u to 10 KVA $iD
Above 80� Am re $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transfonner! Power Su I for Si �s! Outline Li htin $5
0 to 200 Am re $5 �^ ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dweliing Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Trios ta? $20
Fee
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE I _ �
3 to 12 Units @$50 Per Unit (minimum total fee is $20) r��_
E2Ch Addlti0n31 Ulllt @$25 rws naEn Foa uavecTOa usE owr
I hereby certify thffi I inspected the elechical installaGon de;cribed herein on ttie dales spfed:
OTHER ADDITIONAL FEES NFi' �`-� �' °'S
Center Pivot
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑Ready Now � VYdI Call
��You must call the inspector when ready! Date Ready:
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I certify that l am 1�e � ICENSED CONTRACTOR ❑COMPANY ❑ 01NNER and hereby request inspection of Cie electriql work at: