P - 77600REQUEST FOR ELECTRI AL INSPECTIO
1 1.� �— 2 5 9❑0 Minnesota Board of Electriciry �(,��� v�� �p�
�- � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 551 4
(651)642-0800T'fY/MRS 1-800�27-3529 www.electriciry.state.mn.us
EW O REMODEL ❑ ITION ❑ REPAIR Describe -using the bxk f ihe white copy if necessary - the work covered by this request:
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6ENERAL FEES Outdoor Lighting StandaN @$1_
1 0 to 400 Am ere $25 :L06 ''
401 to 800 Am ere S50
Above 800 Am ere $75
IRCUITS I FEEDERS
0 to 200 Am re
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Exh S stem Device or atus $.50
ADDITIONS TO THE GENERAL
Each Additional
ADDITIONAL
er Fixture
�ecial Inspec6on @ $.31 per Mile
INSTALLATION MAY BE ORDI
II�I Ilill IIIII IIIII IIIII IIIII IIIII �III II� IN�
1, 7 4 5 2 5 9 0
Transformers over 10 KVA 5 ZO
Transfortner / Power Supply for Signs I Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � � f��..X�
THIS AAE� FOR INSPECTOR USE ONLY
I hereby certiry that I inspected the eMctrical installa6on described herein on the dates stated:
IF
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Request Date: ', r/ Rough-in Inspedion Required? Yes ❑ No Inspection Other Than Rough-In: ❑Ready Now I�1 Will Call
-� 7� W You must wll the inspecta when ready! Date Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
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AuN(o�rized Signature (Contractor, pany ar w+ner r�ertortnmg instananon�
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61RUC710NS ON BACK OF YE COPY BOARD OF ELECTRICfTV COPY
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Number(s
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Master Electrician or
License Number
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EB-0OOOtA-14 8.1.2002