P - 783861��499-99G �
❑ NEW ❑ REMODEL ❑ ADDITION
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GENERALFEES
0 to 400 Am ere $25
401 to 800 Ampere � $50
Above B00 Ampere @ $75 _
CIRCUITS I FEEDERS
to 200 Ampere @ $5
Above 200 Ampere $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparffius @$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLIN�S PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
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.electricity.state.mn.us
11R Describe -using the back of the white copy if nec th work covered by this request:
_ fl,�n .�;. , .�� �, rA 1�
Standard
Fee $
uptot0i
over 10 Y
ONE & TWO FAMILY DWtLLINGS, tacn urvi i
Includes the Service andlor Power Supply up to 500 Amperes, All
Cirouits and Two Inspection Trips Each Dweliing Unit @$80
Additional Inspection Trips $20
Investiaative Fee
TOTALfEE �
(minimum total fee is $20) p�� —
THIS AREA FOR INSPECTOit I%E ONLV
1 hereby certify that I inspected the elecbical insfallaGon desaibed hereio oa tl� dates sta0ed:
IF
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I I�II O III II (I) II III I) (II II III (I III (I III II (II I� L�
14999965 �'"�/
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Requesl Da : Rough-in Inspection Required? ❑ Yes No Inspedion Other Than Rough-In: ady Now � V1�1 Call
You must call the inspector wh� ready! Date ReadY:
I certify that I am tlie Q4.LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby �equest inspection of the electrical work at: