P - 780631-530-335 ❑7
❑ NEW ❑ REMODEL ❑ ADDITION
GENERALFEES
SERVICES I POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS Of LESS THAN 50 VOLTS
Each S stem Device or aratus $.50
ADDITIONS TO THE GENERAL f
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Addifional Unit @ $25
OTHER ADDITIONAL FEES
Liahtina Retrofit Cd 5.25 oer Fixture
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-08Q0 TTY/MRS 1-800�27-3529 www.electrici �Cte�.us
�, Describe -u in the back of the white copy 'rf e�sary - t e o c this request: �
Traific Si nal Standard $5
Su lemental Fee $20
Transformers u to 10 KVA $10
Tr�sformers over 10 KVA $ 20
Transfortner I Power Su I for Si ns / OuUine Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, Ali
Circuits and Two Inspection Trips Each Dwelling Unit �$80
(minimum total fee is $20) � �J . �U
iM5 MEA FOR INSPECTIX3 u5E CfAv
I hereby certi(y that I inspected the electrical installa6on described herein on the dates sfated:
�--c y �
S ial ins 6on $.31 r Mile -"
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Req e: Rough-in Inspection Required? ❑ Yes Inspection O[her Than Rough-In: y Now ❑ Wfll Call
You must call the inspecta when ready! Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at::
Job Sile Address (Strae BoY. or fioute PIo.1 � Cib � • TD Code __.. _
a
ri��,., � ��
mascer GecuMaan or
License Number
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INSTRUC710NS ON BACK OF YELLOW GOPY BOARD OF ELECTRICITV COPV EB-00001M14 8.1. 2002