P - 77122REQUEST FOR ELECTRICAL INSPECTION ��
1 iJ ��- 4 6 7 0 Minnesota Board of Electricity �- �` .�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ,
Describe -using the back of the white wpy if �ne�ce� ary - the work cover y this request:
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� SERVICES / POWER SUPPLIES
0 to 400 Amaere Cc� $25
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus a$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Manufactured Home Park Lots (
Recreational Vehicle Park Sites
Hour
INSTALLATION MAY BE �
III) II III �III I) III II III II (II I�III II III �� (IIN
1 9 2 1 4 6 7 5
Standard
Fee (a). $
over
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additionallns tionTri s $20
Investigative Fee
Reins ection Fee $20
TOTAL FEE
(minimum total fee is $20)
TMIS AREA FOR INSPECTOit USE ONLV
I herebv certiN that I insDected the electrical installation described herein on the dates staled:
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DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
uate: � Rough-in Inspection Required? ❑ Yes ��lo Inspection Other Than Rough-Ip�m Ready Now ❑ Will Call
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You must call the inspector when ready! Date Ready:
I cerfrfy that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: