P - 79131�} REQUEST FOR ELECTRICAL INSPECTION
1� 716 � U� 0 ��,! � Minnesota Board of Electricity -
�_� 1821 University Avenue Suite 5-128, Saint Paul,Minnesota 55104
.. ` (651) 642-0800 TTYIMRS 1-800-627- w lectricity.state.mn.us
0 NEW ❑ REMODEL ❑ ADDITION RE AIR c� i%ji� thg qpck of t�white copy if necessary - t � Overed by this request:
v�., v � �i i�� ��
GENERAL FEES Outdoor Li hhn Standard $
SERVlCES / POWER SUPPLIES Traffic Sianal Standard !� $5
0 to 400 Am re $25
4D1 to 800 Ampere @ $50
Above 800 Ampere @ $75
TS(FEEDERS
O to 200 Ampere (� $5
� Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CiRCUITS, CIRCUITS OF LESS 7HAN SO VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
�
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
GS PER UNIT TOTAL FEE ��
Per unit (minimum total fee is $20) �
/�R2fj THISRREAFptINSPECi SEONLV
�' �° I hereb ce ' Mat I in
Y r6fy spected the electrical installation Oescribed herein on the dates sfateU:
HER ADDITIONAL FEES �GU ; i� G.� �� 9
.25 per Fixture ��
Hour
Mile
4Y BE
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1 7 1 6 0 8 0 5 �
$ 32 7 �0,50
R�1 Rough-in tnspection Required? ❑ Ves Inspedion Other Than h-1 . WNI Call
You must call the inspector wh� ready! Date Ready:
I certiy fhat I am the �LICENSED CONTRACTOR ❑COIu�ANY ❑ OWNER and hereby request inspe ' n of the electrical work at::
E&0OOO1M14 8.1.20�2