P - 81965� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-377-099 �J 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
- (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity.state.mn. us
Identify the work covered by this request:
O�IEW ❑ REMODEL ❑ ADDITION ❑ REPAIR XGEL ENERGY SAVER'S SWITCH
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Signal Standard �$5
800
/ FEI
� CIRCUtTS. CIRCUITS OF LESS THAN 50
�� Each Svstem Device or Apparatus �
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONA
Lighting Retrofit � $25 per Fi�Aure
Center Pivot Imgatan Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Skes � $5
Separate Bonding Inspection � $20
Special Inspection � $3p per Hour
to 10
� r:;
a.,� ,N
} l�.
• ,r
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$P
Add�ional 1ns�ection Trios � $20
Pee
FOR INSPECrOR USE ONLV
TOTAL FEE
total fee is $201
I hereby certify ihat I inspectetl Me eleqncel installation described herein on the dates sleted:
RWGH IN �A�
FINAL INSVECTION DATE
� 2y �l
FOR OFFICE USE ONLY
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'` 1 3770995'` `��`��
Request Date: Rough-in Inspectian Required? ❑ Yes ❑ Inspection Other Than Rough-in: eady Now ❑ Will Call
Q �� You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: