P - 78678REQUEST FOR ELECTRICAL INSPECTION
�,,, ��F ��- 6 4 5� Minnesota Board of Electricity
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/M RS 1-800�27-3529 www. electricity.state. mn. us
❑ NE REMODEL 0 ADDITION ❑ R R Describe -using the bac of the white copy 'rf n essary - the work c red b this request:
GENERAL FEES Outdoor Li h n andard $1 �
0 to 400 Am ere $25
401 to 800 Am re $50
Above 800 Am re $75
CIRCUITS I FEEDERS
�0 to 200 Ampere @ $5
Above 2(10 Ampere �$10 �
AIARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus 8.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI
3 to 12 Units �$50 Per Unit
Each Additionai Unit � $25
Fixture
S ecial Ins ec6on $30 er Hour
Special Inspection � $.31 per Mile
THIS INSTALLATION MAY BE ORDE
IIIII IIIII IIIII IIIII IIIiI IIIII IIIII II�I hl� Ip�
1 4 3 1 6 4 5 9
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Fee
(minimum total tee is $20) � Qj V.✓V
THIS �RE� FOR INSPECTdi USE ONLY
I hereby cerAfy that I inspec0ed the electrical i�tall� dcscribed harem on the d�es sfa�d:
�-��--��.
� Sa
R� e: O� Rough-in Inspection Required? ❑ Yes � No Inspection Other Than Rough-In: �dy Now U YYRI Call
You must call the inspecta when readyl Date Ready: .
I certify that I am the LICENSED CONTRACTOR ❑ CON�ANY ❑ OWNER and hereby request inspecfion of the elecUical work at:
���.��� �� o,�, �/�'� G� �r� d l� 55��3�
�
,�
� ��
IN87RUC' ANS ON BACK OF YELLOW OPY - BOARD OF ELECiFiICfTY COPV EB-OOOOtM14 8.1. 2002