P - 78375�1-�84-262 �
❑ NEW ❑ REMODEL f�ION �
`- _
0 to 400 An
401 to 800
Above 800
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparffius �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Hour
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1821 University A uite S-128, Saint Paul, Minnesota 55104
(651)642-080 i2 1-800-627-3529 www•electricity.state.mn.us
R Describe -usin ack of the white copy if necessary - the work covered by this request:
� � �
Outdoor LiqhGnq Standard @ $1 _ " / .
Fee $20
ap to 10 KVA
�ver 10 KVA
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
GrcuiLs and Two Inspection Trips Each Dwelling Unit @$BO
( TOTAL FE; I��/�
minimum total fee is $20 iii��
THIS �REA FOR INSPECTqt USE ONLY
I h�eby ceN(y Mffi I inspecEed the elechical instaNafion described herein on tl�e dates sfa�d:
�� �
� � .�� ..... ..-...r .... ..... ...... . ..� ...._ _• �—.�-r—• ° --- - -- --
:<
I IIII II II� II III II III II III II III II III II III II III 1� j�� _
14842629 � �� ` c��'S�
t Dat Rough-in Inspec6on Required? ❑ Yes Inspec�on Otha Than R�wgMn: ❑Ready Now �
Y ust call the inspecla wh� ready! Date R�dy.
I cefify tliat I am U�e ENSED CONTRACTOR ❑ CON�ANY ❑ OWNER and hereby request �spection of the electrical work at:
OF YELLOW COPY
BOARD OF ELECTRICRY COPY
E&00001M74 &7.2002