P - 79620, REQUEST FOR ELECTRICAL INSPECTION
1 � � � � � � � � � Minnesota Board of Electricity s�'-�
�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
+� ����,' (651) 642-0800 TTY/MRS 1-800-627-3529 � ���
www.electricity.state.mn.us J `� `'
identity the work covered by this requesY. ��_
❑NEW �REMODEL ❑ADDITION ❑REPAIR �(� � �Q� ��1/L � ��—% � � �
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere (� $5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svslem Device or Aooaratus ��.50
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
I
Vehicle Park Sites �
idirw Insoection � $:
Outdoor Lighting Standard �
TraTfic Sianal Standard � $5
Transformers over 10 KVA � $20
Transformer / Power Supply for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, A!I
Circuits and Two Inspection Trips Each Dwellin Unii �$8(
Additional Inscection Tri�s � $20
Fee �
total fee is
I insoected the electrical instailatian described herein on the dates stated:
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S ial Ins tion C� $.3 r i U�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
WR OFFICE USE ONLY
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Requesj Date: pough-in Inspection Required? ❑ Yes No Inspectfon Other Than Fiough-In: ❑ Ready Now Will Call
�l ���� You must call the inspecror when ready! pate Ready:
I cer�iy that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: