P - 79863. REQUEST FOR ELECTRICAL INSPECTION
1c3 0 7 0 3 4 x Minnesota Board of Electricity --
� � m� n. 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� �� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electrictty.state.mn.us r-- ���_
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR ��, , � �
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CO
CIRCUITS, CIRCUITS OF LESS THAN 50
Each S stem Device or ratus �
ADDITIONS TO THE GE�
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unft
Each Additional Unit � $25
OTHER ADDITIONAI
Li htin Retrofit �$25 r Fixture
Center Pivot Irri ation Boom @$40
Manufactured Home Park Lots � S25
— Outddor Li htin Standard � $1
TraKc Si nal Siandard � $5
Su plementai Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li Min �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service ar�d/or Power Supply up to 500 Amperes, All
SIGNALING Circuits and Two InspecGon Trips Each Dwelli Unft �$8(
Additional Insoection Trips � $20
Fee �
iimum total fee is $�C�
29s���
lation described herein on tlie daT
S ial Ins 'on � $30 r Hour '"'""""""""' � _ � `z� ��
Special Ir�spection � $.31 per Mife
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF N MPLETED WITHIN 18'MONTHS
FOR OFFlCE USE ONLY
41I11111111IIIIIIIiIHll1l111111ilklllllllllllfll! 296��
� 1 � � � 0 3 4 � � R�,yoB� �a,so
Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection O[her Than Rough-I � Now ❑ Will Call
��/�' Yau must call the inspeclor when ready! Date Ready:
I certity that I am 1q�SCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical xrorVc a�