P - 77116REQUEST FOR ELECTRICAL INSPECTION
1� J� lJ - 7 6 3� Minnesota Board of Electricity �-. :
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back t white copy if n wo cove d by t is uest:
Standard
0 to 400
0 to 200 Am ere $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNI7
Above 200 Am ere $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s$20
Each S stem Device or A aratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ction Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 units @$50 Per Unit (minimum total fee is $20)
EeCh Addit10081 Unit @$25 *His nRen Foe iNSVeeroa use ou�v
OTHER ADDITIONAL fEES
Li(]htin9 RehOfit a(� $25 Def FiMute 1 herebY certify that 1 inspeded the elechical inatallation descnbed herein on Me dates stated:
is ion $30 r Hour ""'"`�,"°°"w"`°
ispection (c� $.31 per Mile
'ALLATION MAY BE ORDERED DISCONNECT�,D IF NOT COMPLETED WITF
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19307636
Date: Rough-in Inspection Required9 ❑ Yes ❑ No Inspectlon Other Than Rough-In: [�1teady Now ❑ Will Call
�'��� � You must call the inspector when ready! Date Ready: /`
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I certity that I am.the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address � C' n
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or Owner � rmmg instauation) Piease ProHae 7wa (2) f�hone rvumbers mcwd�ng Area co
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