P - 77683o � REQUEST FOR ELECTRICAL INSPECTI N �""'�
1� v� ��. �� 2 3� Minnesota Board of Electricity ��� —��� �� :�
„ 1821 University Avenue Suite S-128, S n aul, mnesota
(651) 642-0800 TTYIMRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
GENERAL FEES Outdoor Lightin Standard a$1
0 to 400
401 to 8
Above 8
zM, COMMUNICATION, REMOTE CONTROL,
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
fIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units na $50 Per Unit
OTHER ADDITIONAL FEES
ofit @ $.25 per Fi#ure
Irrigation Boom @ $40
i Home Park Lots @ $25
Vehicle Park Sites (� $5
Traffic Si nal Standard $5
Supplemental Fee $20
Transformers u to 10 KVA $10
Transformers over 70 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Insoection Tri�s C� $20
TOTAL FEE
totai fee is $20F �
I hereby certify that I inspected the electncal installation described herein on the dates stated:
ROUGH IN pp�
Fiwu inscECnon onre
/o • L— �S
Speclal Inspection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF
I li�l II II! II III II III II III II III II III II III p�I I�
18556233
WITHIN 12
_
Date:� Rou h-in Ins ection Re uired? p g ❑ Ready No Will Call
(q 9 p q ❑Yes o Ins ectionOtherThanRou h-In:
P� VJ You must call the inspector when ready! Date Ready:
I certify that I am th LICENSED CONTRACTOR� ❑ COMPANY ❑ OWNER and hereby request inspection of the elecVical work at:
Job Site Street Address . . �....
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Please Provide Two (2) Phone Numbers Induding Area Code
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r License Number Master Electrician or Power Limited Techni
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OPY EB-00001A-15 87