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REQUEST FOR ELECTRICAL INSPECTION � �'
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCURS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A iatus @$.50
ADDRIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UN
3 to 12 Units @$50 Per Unit
Each Additional Unit (a� $25
OTHER ADDRIONAL FEES
Lightin Retroffi @ $.25 per Fixture
Center Pivot Irrigatlon Boom $40
Manufactured Home Park Lots $25
Recreadonal Vehlcle Park Sftes $5
Se Bomiin Ins 'on $20
Special Ir�s�ctlon @ $30 per Hour
Special Ins�cGon @ $.31 �r Mite
THIS INSTALLATION MAY BE aRDERED DI
IISSI �I� II�I III� li�I IC{II III� III� �� I�
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ONE & TWO FAMILY DWEWNGS, EACH UNIT
Includes the Service andlor Power Supply up W 500 Amperes, Au
Circuits and Two Inspedion Trips Each Dwelling Unit @$BO
Additional Ins 'on Tri @ $20
Investigative Fee
Reins 'on Fee $ZO
TOTALFEE
(minimum total fee is $20) �
7 WS PREA FIXt WSPECIOR IuE OM.Y
I hereby certHy fhaf I inspected the electrical inslallatlon descxibed hereln on the dates stated:
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��� � Rough-in Ins�recdon Requfred? ❑ Yes No Inspedion Other Then Rough-In: ❑ Ready N�Will Call
$ � � You must cell the inspec�or when read Date Ready. ' `
I ce that I am the ICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request insp�tion af the electrical work at
Job Site Street Addr�s City
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License Number
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