P - 78006REQUEST FOR ELECTRICAL INSPECTION
1� 5 7 4���� � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.e[ectricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION p REPAIR Describe -using the back o�e white copy if necessary - the o�C covered by this request:
GENERALFEES
401 to 800 Am re $50
Above 800 Am re $75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus 5.50
ADDITIONS TO THE �ENERAL FEES
Each Addi6onal Unit
Center
,
Traffic Signal Standazd
Suoolemental Fee � S
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE I �J�� .�,
(minimum total fee is $20) /�([�
,ws utEn For� uaPEO.at usE «a.
I hereby certily that I inspected the electrical insialla6on described heiein on the dates sfated:
Hour `"""`�,"°^""""
Mile
4Y BE ORDERED DISCONNECTED IF t�
INIaIII����IIIIIIII�IIIIIIII��� INN
15743313
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Request Date: .1 Rough-in Inspection Required? ❑ Yes �Mo Inspection Other Than Rough-In: LJReady Now�1M/II Call
f�-� Q, - o: You must call the inspecta when ready! Date Ready:
I certify that I am the �Q.ICENSED CONTRACTOR '� COMPANY ❑ OWNER and hereby request inspection of 1he electrical work at::