P - 77498REQUEST FOR ELECTRICAL INSPECTION
2� o��� 7 4�� Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-6273529 www.electricity.state.mn. us
Descri usi the back of Re co 'rf necessa the work co er b this r ue
� .��i _ _ � PY _ ry- i � y � �..�� n .,
401 to 800 Am ere a$50
Above 800 Am ere �$75
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units (a� $50 Per Unit
OTHER ADDITIONAL FEES
� Retrofit @ $25 per Fixture
Pivot Irriqation Boom na $40
Standard
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su 1 for S' ns I Oudine Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling UnR @$80
Additional Ins ction Tri s $20
Investigative Fee
Reinspection Fee $20
TOTAL FEE
(minimum total fee is $20) o
THISAREAFORINSPECTORUSE LY
I hereby certi(y that I inspeded the elecVical installa6on desaibed herein on Ne dates stated:
2—�za7 I
S ecial Inspection g30 per Hour E""�°�^B^"°°ae°'� pA,�
S ial Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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te: O Rou h-in Ins eq spection Other Than Rough-In: eady Now ❑ Will Call
g pecGonR uired? ❑Yes o In
You must call fhe inspector when ready! Date Ready:
I certify that 1 am the ❑ LICENSED CONTRACTOR OMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address � � ���, ��. ��
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��g r�aaress ��.onvac[o�, company ar
440 Kilmer Lar
o d Siynatu ConVa ror
CTIONS ON BACK O E LOW COPV
Please Provide Two (2) Phone Numbers
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ise Number Master Electriaan or P
License Number
North P
i�aaon� Please Provide Two (2) Phone Numbers Including Area Code
� �76�544-3300� )
BOARD OF ELECTRICITV COPY EB-00001A-15 8.1. 2004