P - 784141-494-039 �
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❑ NEW ❑ REMODEL DD N 0 f
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REQUEST FOR ELECTRICAL INSPECTION -
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
2-0800 T'fY/MRS 1-800-627-3529 www.electriciry.state.mn.us
cribe -using th ack of the white copy if necessary - the work covered by this request:
Outdoo LiQh6nq Standard (rD $1
401 to 800 Am ere $50
Above 800 Am re $75
CIRCUITS I FEEDERS
0 to 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL
Liah6na Rehofit (� 8.25 oer Fixture
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two inspec6on Trips Each Dwelling Unit @$60
TOTAL FEE I � •�
(minimum total fee is $20) Q�
TNIS AREA Fqi INSPECTp1 USE OKV
I hereby certify that I inspected the electrical installa6on described herdn on the dates stffied:
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Request Date: Rough-in Inspection Required? O Yes ❑ No 'on Oth� Tha n: dy Now ❑ WNI Call
�� O You must call the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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ELECTRIC:
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INS7RUC" �OpB ON BACK OF Y�Ii6YrCOPY BOARD OF ELECTRICITV COPY
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Master EJectriaan or Power Limited T chnician
License Number /
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. EB-00001M14 8.1.2002