P - 760041 7� 7 0 7� � REQUEST FOR ELECTRICAL INSPECTION
� � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.elech-icity.state.mn.us
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GENERALFEES
, CIRCUITS OF LESS THAN 50 VOLTS
System Device or Apparatus @ $.5D
ADDITIONS TO THE GENERAL i
MLY DWELLINGS (PER UNIn
2 Units � $50 Per Unit
Additipnal Unit @ $25
OTHER ADDITIONAL FEES
na Retrofit Ca? $.25 oer Fi�ure
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17870783
Supplemental Fee @ 9
Transformers up to 10
Transformers over 10 I
Includes the Service and/or Power Supply up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Dwelling Unft @$80
Additional Ins ction Tri $20
Inves6gative Fee
Reinspection Fee @ $20
TOTAL FEE e: o ..
(minimum total fee is $20)
Txis u�a Foa wsaecrort u� oNtv
I hereby certify thaf I inspected the electrical installelion describ�i herein on the dates steted:
DISCONNECTED_IF NOT COMPLETED W
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g_ a�--or
��' Rough-in Inspection Requiredl ❑ Ye �] No Inspection Other Than Rough-In: �teady Now ❑ WIII Call
$' ��, �� You must call the inspector when readyl Date Ready:
I ce�iiy that I am the [�J LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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