P - 79000�`(� REQUEST FOR ELECTRICAL INSPECTION
1� G�J 5� 5� 8� Minnesota Board of Electriciry -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�' (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
NEW ❑ REMODEL ❑ ADDITION 0 REP R Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Liqh6nq Standard �$1
401 to 800 Am re $50
Above 800 Ampere @ $75
CIRCUITS I FEEDERS
0 to 200 Ampere @ $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
12 Units @ $50 Per Un
i Addi6onal Unit @ $25
0
ONE & TWO FAMILV DWELLINGS, EACH UNIT
Includes the Senice and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliing Unit @$80
Reins tion Fee $20
TOTAL FEE . �
(minimum total fee is $20) �
iH15 AREA fIXt INSPECTOR USE pSV
I pereby cer6fy tl�at � inspecled the elecbical inshallation described herein on the dafes sGted:
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�� �� Rough-in Inspection Required? ❑ Yes No Inspedicn pther Than Rough-In: dy Now ❑ VNII Call
6����� y You must call fhe inspeclor when ready! Date R�dy:
I cerMy that I am tt�e�ICENSED CONTRACTOR OCOMPANY ❑ OWNER and heieby request inspection of tlie elecUical work at:
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