P - 781071-5�2-��5�
❑ NEW ❑ REMODEL O
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FEES
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of ElecUiaty
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800-627-3529 www.electriciry.state.mn.us
� Describe -using the back of ihe white copy if necessary - ihe wak covered by ihis request:
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus � 5.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
OTHER ADDITIONAL FEES
Retrofit � E.25 oer Fixture
�
ing Standard
Standard A
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @ a80
TOTALFEE
(minimum total fee is $20) ��,�
THIS AREA FOR NbPECTOR USE d1Y
I hereby cerGy Mat I inspected the electrical insfalla0on daaibed herein on the d�rs stakd:
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ReQuest Date. Rough-in inspection Required? ❑ Yes Inspedion Other Than RougtNn: ❑Ready Now Wfll Call
r.. rD You must call tl�e inspector when ready! Dete Reedy:
I certify that I am the �ICENSED CONTRACTOR ❑ CON�ANY ❑ OWNER and hereby request mspection of the electricai work at: