P - 79304❑ REQUEST FOR ELECTRICAL INSPECTION
� I ���- 5 6 4 p Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
r (651)642-08001TY/MRS 1-800-627-3529 www.electriciry.state.mn.us
NEW O REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
?�GEL EPIERGY Sf�VER`S SV�.fIT�i�
GENERAL FEES Outdoor Liqhtinq Standard (�a $1
401 to
IFEEDERS
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUI7S OF LESS THAN 50 VOLTS
Each Svstem Device or APOaratus � 5.50
3 to 12 Units
Traosformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer / Power Supply fa Signs I OuUine Lighting �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Per unit (minimum total fee is $20) � �20.50
� C25 iH15 AREA Fpt iNSPECiOR USE OKv
� I hereby cerUry that I inspected the elechicai installation described herein on the dartes sta0ed:
HER ADDITIONAL FEES '7
.25 oer Fixture ,i-G � — G' � � %
Mile
2 _ /T �y
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS _ �
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Request Dete: Rough-in Inspeclion Required? ❑ Yes Q'Fb I Inspedion Other Than RougMn: Of�ady Nav Q Vvll Call
���{� You must call the inspecta when ready! Date Ready:
I certify that I am tt�e Cy�ICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of tlie elecfic;al work at:
INSTRUGTONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPV EB-00001M14 8.1. 2002