P - 81852REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
r 1-375-412 � 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity, sta te. mn. us
IdentiTy the work covered by this request:
q�IEW ❑ REMODEL ❑ ADDITION ❑ REPAIR ifGEL ENERGY SAVER'S SVIIITCH
401
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMiLY DWELLINGS (PER UNIT)
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
� $30 per Hour
� $.31 per Mile
to 10
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and 7wo Inspection Trips Each Dwelling Unit �$80
Additional Ins�ection Trios � $20
� Reinspection Fee � $20
(minim
FOfl INSPECTOF USE ONLY
I Aereby certity ihat I inspected the electrical installelia
ROUGH IN
FIN�L INSPECTIa! � �J
i�
���: .
!INECTED JF _ _ COMPLETED
FOR OFFlCE USE ONLY
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TOTAL FEE
herein ai 1he datea atatetl:
onre
UATE
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* 1 37541 22* 02��50
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 certity that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he�e6y request inspection of the electrical work at: