P - 781581-525-845 �
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❑ NEW ❑ REMODEL ❑ ADDITION
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GENERALFEES
SERVICES / POWER SUPPLIES
0 to 400 Am re $25
401 to 800 Amoere (a4 S50
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1827 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800-627-3529 www.electricity.state.mn.us
AIR Describe -using the back of the de copy if necessary - the work covered by this request:
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I 0 to 200 Ampere �$5
� Above 200 Ampere an.$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @ 3.50
ADDITIONS TO THE GENERAL FEES
2 Units @ $50 Per Unit
Additional Unit @ $25
Boom $4(
ark Lots $
'ark Sites
�ection $2�
i30 cer Hour
Traffic Sianal Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, Ali
Circuits and Two InspecGon Trips Each Dwelling Unit �$60
TOTAL FEE I �
(minimum total fee is $20) � Q
iM5 MEA FCR IIbPECiOR USE Mv
I hereby cerGy that I inspected the electrical instaila6on described herein on the dates stated:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS __a
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Requ/est Dete: Rough-in Inspection Required? ❑ Yes No Inspedion Other Than Rough-In: ❑Ready Now Will Call
(� —' 7' �/ y Yau must wll the inspecla when ready! Dale Ready:
I certiy that I am tt�e �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
�wa�nw i�s on owc�c ��eLLq�l CppY BOARp OF ELECTRICRV COPV EB-OOOOtA-14 8.1. T002