P - 81850REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
� 1-375-410 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www. electriciry. sta te. mn. us
Identify the work covered by this request:
O�IEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
CIRCUITS ! FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRGUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Ap aratus �$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS (PER UNI
3 to 12 Units (� $50 Per Unit
Each Additional UnN � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irriqation Boom � $40
0
to10KVA�$10
ONE & TVNO 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
Additional Insoection Trios � $20
TOTAL FEE �
(minimum tofal fee is $20
FOR MSPECTOP USE ONLY
I hereby certiy Mat I inspected Me electrical installaNOn describetl herein on tlre Aates stetetl:
ROUGHIN DATE
FlNAL INSPECTION . OAtE
� � �d_o(
�NECTED IF COMPLETEQJNITH1�11�.MClIlLTtIS_ �_,
FOR OFFICE USE ONLY
I Illiil 11111 �4111111111111 Iliii IIIM�I� �� I� ��-�� �� •
* 1 37541 06* aD,SO
Request Date: Rough-in Inspection Required? ❑ Yes ❑ Inspection Other Than Rough-in: eady Now ❑ Will Call
�� �� You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CQNTRACTOR ❑ GOMPANY ❑ OWNER and hereby request inspection of the electrical work at: