P - 78360REQUEST FOR ELECTRICAL INSPECTION
1� 3 4 7�� Q 6 �` Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� �� (651) 642-0800 TTY/MRS 1-800-627-3529 - _
, www.electriciry.state.mn.us
IdeMify the work covered by this request: � /
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❑ NEW EMODEL ❑ ADDITION ❑ REPAIR � —
to 800
S / FEEDERS
200 Amcere 4
IITS OF LESS THAN 50 VOLTS
Device or Aooaratus � �_5n
FEES
Manufactured Home Park Lots �
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li hti �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Tri s Each Dwelli Unit �$80
Additional Ins ion Tri � $20
Investi ative Fee
Reins ion Fee � $20
� TOTA E
(minimum total fee ' 20)
PoF INSPECT017 USE ONLY
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I hereby cerlity that I inspec[ed tlie electrical installalion described herein on tl� dates s
s �NSrA�LATION MAY BE ORDERED DISCONNECTED IF NOT COMPLEI
FOR OFflCE U8E ONLY
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WITHIN 18 MOI
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I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: