P - 81984� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
- 1-377-492 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642-0800 TTY/MRS 1-500-627-3529
www, electricity. sta te. mn. us
Ideniiiy the work covered by this request:
OMIEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERALFEES
401 to
0
� ALARM, COMMUNICATION, REMOTE CONTROL, SIGNAUNG
TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$5a Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
i4CEL ENERGY BAVER'� SWITCH
Outdoor Liphtinq Standard � $1
Transfortnere u to 10 KYA � g10
Transfortners over 10 KVA � $20
� Transfortners / Power Supply for Signs / Outline LighNng �$;
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and�or Power Supply up to 500 Amperes, pll
Circuits and Two Inspection Trips Each Dwelling Unit �$8�
FOP INSGECTOR USE ONLY
I hereby Certity ih
ROUGM IN
FINAL INSPECTION
TOTAL FEE
herein on the detes stetetl:
� � I
FOR OFFICE USE ONLY
illiililllllll{fi{Iil{IIIIIIIHI�II��II(Ifllll�l ,�
*13774922* � ����
Request Date: Rough-in Inspeclion Required? ❑ Yes ❑ Inspection Other Than Rough-in: eady Now ❑�II Call
7 � You must call the inspector when ready! Date Ready:
I certiiy that 1 am the L� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wo�C at: