P - 77043REQUEST FOR ELECTRICAL SPECTION � '��
I r QQ% ❑ Minnesota Board of Electricity � ba� (� �-: �
1�3 8 5� V J 1 � 1821 University Avenue Suite S-128, Saint Paul, Minneso�55104
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(651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us t��"
Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li hting Standard $t
SERVICES / POWER SUPPLIES Traffic Sianal Standard (c� $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aoparatus a(� $.50 �
Each Additional Unit @ $25
OTHER ADDITIO
Lighting Retrofit @ $.25 per Fixture
Center Pivot Imqation Boom (� $4(
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investioative Fee
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(minimum total fee is $20) oc1�-� � �J�
I inspeded the electrical inslallation described herein on the dafes stated:
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Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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18858977
uace: Rou h-in Ins ection Re uired?
g p q ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now yUill Call
!�i 1' �' ��- 1 You must call the inspector when ready! Date Ready:
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I certify that I am the�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site SVeet Address Cit�,
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Please Provide Two (2) Phone Numbers Including Area Code
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Ry Address
pC Conhactor License Number Master Electncian or
C+J , � ,� �., � , � � , License Number
� nutnoify9a SlgnaW►e (GOif[f8Ct8f or UwTf�Y Pe�f7omli�lg �nsTall$fior� --- - P Provide Two (2) Pho umbers Includi Area Code
i (7b3� 783-7080 ::i� � )
INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY EB-00001A-15 8.1. 2004