P - 81961j REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
. 1-376-896 � 1821 University Avenue Suite S-128, Saint Paui, Minnesota 551�4
(651) 642-0800 1TY/MRS 1-800-627-3529
www.electricity.state.mn.us '
� Iderttify the work covered by this request:
to 400 Ampere �
Above 200 Am ere C� $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS (PER UNI�
3 to l2 Units C�? $50 Per Unii
Each AddiGonal Unit � $25
OTHER ADDITIONAL FEES
$li@S �
Dfl � �i
�
�
%GEL ENERGY SAVER'� �WITCH
Transformers u t0 10 KVA �$16
Transfortners over 1Q KVA � $2Q
Transfortners / Power Supply for Signs / Outline Lighting �$!
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
CircuRs and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips � $20
� Investiaative Fee
FOFl INSPECTOR USE ONIY
I hereby certiy th
ROUGH IN
FIWLL INSPECTqN
TOTAL FEE
total fee is $20)
herein on the dates steted:
DPTE
�.- a Z
FOR OFFlCE USE ONLY
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Request Dafe: Rough-in fnspeclion Required? ❑ Yes ❑ o Inspection Other Than Rough-in: eady Now ❑ Will Call
��1 %�1 You must call the inspector when ready! Date Ready:
I cedify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: