E - 78939REQUEST FOR ELECTRICAL INSPECTION
1� 615 - 519 ❑4 Minnesota Board of Electricity -
1821 University Avenue Su -128, Saint Paul, Minnesota 551�4
(651) 642-OSQO TTY/M -627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMOpE ADDITI N❑ REPAfR Describe -usiy g the back ite copy if n essary - the work covered by this request:
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SERVICES / POWER SUPPLIES
0 to 400 Am ere $25
401 to 800 Am ere $50
Above 800 Am re $75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 20D Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus $.50
ADDITIONS TO THE GENER4L I
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL
Liohtino Retrofit f� $.25 cer Fixture r
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � �1 �j
iH15 APEA FOR INSPECTpi USE ONLV
I hereby cerGfy that I inspec0ed the electric� installa6on described herein on the dates sia0ed:
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f certiiy that I am the
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Rough-in Inspedion Required? ❑ Y� No Inspedion Ofher Then Rough-In: Ready I�w � Nhll Call
You must call the inspector when ready! Dete Ready:
INSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical wak at:
Roule No.) C _..+� P Code
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Performing Insfallationj
BOARD OF ELEC7RICT' COPY
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