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GENERALFEES
401 to 800
Above 800
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity a`
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)'642-08001'TY/MRS 1-800-627-3529 www.electricity.state.mn.us
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device w aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Unfts Ca4 $50 Per Unit
Center Pivot Irrigation Boom �
Manufactwed Home Park Lots
Fee
Includes the Service andlor Power Supply up to 500 Ampetes, All
CircuRs and Two Inspection Trips Each Dwelling Unit (a� b80
Additanall� ' Tri S20
Invesf ' Fee
Reins �on Fce $20
TOTALFEE
(minimum total fee is $20) �0 . C%
n��s uun Fon xur+�crort use aar
I hereby cerMY Ihat I inspected tl�e electrical installafion desaibed herein on the dates steted:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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REC'D JUL -,�2007
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g spec[ion Requiredl ❑ Yes o Inspection Other Than Rough-In: ❑ R�dy Now�IViA Call
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Z� `Q You must call the inspector when ready! Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspedion of ihe elecUical work at
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Township Sec�on Range Fire No. Co�
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Ovmer/Occupant Name Please Provide Two (2) Phone Numbers Induding Area Code
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ConVador / Company Name � � Contrador License Number Master Electriaan w Power Limiled Techniaan
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Mailing Address� (Contr��, Company orn '� eMr Perfortning Install� ) Q��, �� ��
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Please Provide Two (2) Phone Numbers InGuding Area Code
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