P - 79245REQUEST FOR ELECTRICAL INSPECTION �'
�`�� 0- 6 4 0� Minnesota Board of Electricity !-
s � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITIpN_ OREp�+� _pgscube= usina (t� b,�VS Q(,(hg�hite copy if necessary - the work covered by this request:
GENERALFEES
0 to 400
CIRCUITS OF LESS THAN 5D VOLTS
Fee @ S20
uo to 10 KVA an $10
ONE 8 TWO FAMILY DWELLINGS, EACH UN1T
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
$50 Per Unit (minimum total fee is $20) � 20,50
Unit @$25 �ws u�n Foa ir+saECTOa usE aa.
—T 1 hereby tertiry that I inspected the elettrical insWla6on described herein on the dates sta0ed:
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S iai Ins tion $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ Inspedion O[h� Than Rough-In: ❑ dy NaYv � Will Call
07�a� You must call the inspecla when ready! Date Ready:
I certify that I am ihe ❑�ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
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