P - 79251G
REQUEST FOR ELECTRICAL INSPECTION
�� 1� O- 6 4 6 � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
` (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us ""
NEW ❑ REMODEL ❑ ADDITiqCEL �NERGYsc�be -, u,�ingt� b�ua�k 2fs.hg Hite copy if necessary - the work covered by this request
�{ AdCK W1TC:
FEES
401 to 800
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Exh System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL I
fIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Traffic Si nal Standard a$5
Su lemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns I Outline Li htin $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 @$60
Additional Inspec6on Trips . $20
InvesGaative Fee
TOTAL FEE I �0,50
(minimum total fee is $20)
THIS ARFA fIXi IrvSPECTdi IbE 0l1Y
I hereby cer6fy tl�at I inspected the elechic� ir�statla6on described herein on tlie da�s s�d:
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VSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITFiIN 72 MvN TMS
I IIlI II III II I� II III II III il IN d III II III N�I Ii�l
R4699
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspedion Other Than Rough-In: ❑ y Now ❑ Wdl Call
d7��� You musl call the inspeclor when ready! Date Ready:
I ceRity that I am the ❑%LICENSED CONTRACTOR �COMPANY ❑ OWNER and hereby request inspection of the elecUical work at::
INSTRUC710N8 ON BAGK OF VELLOW COPY BOARD OF ELECTRICITV COPV EB-00007M11 8.7. 2002