P - 79767' REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
� 1-396-�J4�J � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn. us
Identity the work covered by this request:
U NEW ❑ REMODEL O ADDITION ❑ REPAIR �L ENERQY SAVER�S SWITCH
to
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortners I Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS Additional Inspection Trips �$20
Each S stem Device or paratus �$.50 Investi ative Fee
ADDITIONS TO THF GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS (PER UNI� TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20
Farh A�Iriifinnal Ilnit � 4�S FOflINSPECTOflU5E0NLY
Center Pivot Irri ation Boom �$40 `
Manufactured Home Park Lots (� $ I hereby certify thet I inspected the electrical instellation described herein ai the detes stated:
Recreational Vehicle Park SRes �$5 RWOH IN DATE
te Bondin Ins ion � $20
S ial Ins eCtion �$30 r Hour FINAL INSPECTION DATE
S ial Ins ection � $.31 er Mile � � % � � �
__ Tli1S INSTALIATIQN MAY_�E.�RD.EREQ�LS_Sr9N1'1�S�i3�1F_dS2LCSMPLETED 1Q�ITHIN 81 MONTHS
� FOR OFFICE USE ONLY
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* 1 3965454* ����b�
Reque Rough-in InspecGon Required? ❑ Yes No Inspection Other Than Rough-in: Ready Now ❑�II Call
You must call the inspector when ready! Date Ready:
I certify that I am the C7 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
tt3-00007A-73 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY