P - 777511-676-547 �1
0 NEW ❑ REMODEI ❑ ADDITION REP�
�
GENERALFEES
SERVICES / POWER SUPPLIES
0 to 400 Amcere � $25 -�
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�27-3529 www.electricity.state.mn.us
R Describe -using the back M ihe white copy if necessary - the work covered by this request:
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS Of LESS THAN 50 VOLTS
Each Svstem Device or Aooaralus (� 5.50
2 Units @ $50 Per Unit
Additional Unit @ S25
1 Boom $4C
Park Lots $
Park Sites ;
s tion $21
330 cer Hour
I�IIIII I�IIIIIIII �IIII (IIIIIIIII IIIII �� I�
Traffic Signal Standard
Suoolemental Fee C� S
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
TOTALFEE
(minimum total fee is $20)
THI$ �REA Fpt INSPE(
I hereby certify Mat I inspected tlre elec�l.i�
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�rn_rn me yates stated:
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onrE
OMPLETED WITHIN 12 MONTHS
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Request Dffie: Roughin Inspection Required? ❑ Ygs Inspectian Other Than R
ough-In: y Now ❑ VYII Call
'� .� S You must call the inspecta when ready! Dale Ready:
I certify that I am the �LICENSED CONTRACTOR 0 COMPANY ❑ OWNER and hereby request inspection of the electrical work at::