P - 784091-4�9-967 �6
❑ NEW ❑ REMODEL ❑ ADDITION �
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GENERALFEES
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-80D-627-3529 www.electricity.state.mn.us
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REPAIR Describe -using the bac of ite copy if necessary - the work covered by this request:
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERAL FEES
iIFAMILY DWELLINGS (PER UNIn
3 to 12 Units �$50 Per Unit
Each Additional Unit @ $25
Hour
Mile
IIII IIIII IIIII IIIII I�III I�III (IIII IIIII I�� I�
1499967E�
Outdoor Liahtina Standard
�ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
CircuiGs and Two Inspection Trips Each Dwelling Unit @$80
Reins tion Fee $20
TOTAL FEE SO
(minimum total fee is $20) �Q ---�
THISAREAFIXi1N5PECTIXiUSEIXJLV �
I hereby cerdy that I inspected�the electrical installa6on desaibed I�ein on the da�s sf�ed:
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ReQues► �ffie: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Ragh-In: ❑Ready Now � Wfll Call
g� You must call the inspector when readyl Date Ready: �/� �
I certiiy that I am tt�e �ICENSED CONTRACTOR OCOMPANY ❑ OWNER and hereby request inspection of the elecfical xrork at: