P - 81912REQUEST FOR ELECTRICAL INSPECTION
1 1 U 3 2 4 0 e' Minnesota Board of Electricity
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� � � „`, (651) 642-0800 TTY/MRS 1-800-627-3b29
www.edectricity.state.mn. us
identiiy the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION � EPAIR Y�,WIPFV'/ �� 1r-1 (`� �y( �Xii/" �1 L L_Jw(J 1 c
Traffic Sianal Standard �
0 to 400 Am re �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA �$70
Above S00 Am ere f� $75 Transformers over 10 KVA f� $20
�UITS / FEEDERS TransSormer 1 Power Su for Si ns ! Outiine Li htin t� $5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIS
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 5� Amperes, All
RM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$8(
CUITS. CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Trios �$20
Each Svstem Device or Apparatus �
Each Additional Unit �
FEES
Fee �
tOtal fee is
Manutactured Home Pa�k Lots �$25 r.�. ... J. _ I I herebvi ce�titv mat I insnec�ed the elecirical instaNauon desaibed t�ere4n on me aa�es
Special Inspection �$.37 per Mile t �� 2' � G y �
� THIS INSTALLATIOPI MAY BE ORDERED DISCONNECTED IF COMPLETED WITHIN 18 MONTHS
FOR OFRCE U8E ONLY
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Requ� D te: /� Rough-in Inspection Required? ❑ Yes o Inspection Other Than Rough-In: eady Now � 1Ktlf CaN
"� �� , � You must call the irispector when readyl Date Ready:
I certify that I am the�NSED CONTRACTOR ❑ COMPAIVY �[] OWNER and hereby request inspection of the electrical work at: