P - 765851—���5-951 ❑4
❑REMODEL OADDITION ❑ REPAI
wi�e Ne�v �ame
GENERALFEES
0 to 400 Am ere $25
401 to 800 Am ere a50
Above 800 Am ere $75
CIRCUITS I FEEDERS
to 200 Ampere p E5
Above 2(10 Ampere �$10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus (� 5.50
REQUES� FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity -
1827 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
R Describe -using the back of the white copy if necessary - the xrork covered by this request:
1
Traffic Signal Standard
Suoolementai Fee C� 8
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, Ali
Circuits and Two Inspection Trips Each Dwelling Unit @$60
MULTIFAMILY DWELLINGS PER UNIT ���,3 V(mlfllfilUm t0181 f2e�$20) V 0• �+ y�" O�f
3 to 12 Units @$50 Per Unit
E2Ch Addi50n21 U�il @$25 rws ui� Fae rc�croa usE arxr
I herebr ce[fify Mat I inspecfed tAe ekttrical installation descnbed herein on the da0es st�ed:
OTHER ADDITIONAL FEES �p �j
1 inhfinn Rahnfif G�i S 75 rwr Firhim � S%
Hour
Mile
IIIII (IIII IIIII IIIII IIIII IIIII IIIII IIIII I� III�I
16859514
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onrE
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OMPLETED WITHIN 12 MONTHS _ �
T�l�
(z6%
�.��C%'� - C� � % �S
Re9uesi ua�e: Roughin I�spection Required? �Yes ❑ No Inspettian Other Than Rough-In: ❑Ready Now Will Call
t�2�'0� You must call the inspector when ready! Date Ready.
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he2by request inspection of the electrical work at::
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