P - 78733REQUEST FOR ELECTRICAL INSPECTION
1�' �} �,�, - 715 � 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 ❑ ADDITION ❑ REPAIR Describe -usi the back of tlTe white copy if nec s - the work co ered by this quest:
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IPOWER
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$•50
ADDITIONS TO THE GENERAL
fIFAMILY DWELLINGS (PER UNIn
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Supply for Signs I OuUine Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Indudes fhe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwellir�g Unit �$80
Additionallnspection Trips $20
InvestiaaYive Fee
TOTAL FEE
(minimum total fee a $20)
TMIS ARER FIXt INSPECTd3115E dir
I hereby cerCy that I inspected the elec9ic� instatl�on desixibed he�ein on the da�s st�ed:
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3rate eonam ms non a�u c,i v • p„�
:ial ins 'on $30 r Fbur �o�
,i� Inspection $ 31 per Mile
NSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITMIN _iz mVn i n�_ �
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I certify that I am the
�Job Site dress �(She
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Rough-in Inspedion Required? ❑ Ves ❑ No Inspedion Other Than RougMn: dy Now � Will Call
You must call the inspedor when ready� Date R�dy
:NSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe elechical work at::
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1�NDA�L� ELECTRlO: INC�
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INSTRUC"
Please Provide Two (2) Phone Pkimber(s�
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ConVactor License Number Mester FJectridan a P
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BOARD OF ELECTRICIT' COPY EB-00001M14 8.7. 2002