P - 77030(� REQUEST FOR ELECTRICAL INSPECTION �;���'�°'�
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1 � (j � � � 1 � 7 � Minnesota Board of Electricity �"'�-d�pp� / <; ,,� �
1821 University Avenue Suite 5-128, �aint Paul, Minnesota 55304 �.
�6$�8 (651)642-0800TTY/MRS1-800-627-3529www.electriciry.state.mn.us ����
Describe -using the back of the white copy if necessary - ihe work covered by this request:
Repair storm damaged service entrance mast.
GENERAL FEES Outdoor Li htin Standard $i
SERVICES I POWER SUPPLIES _ Traffic Sianal Standard (a� $5
� Above 800 Ampere @ $75
CIRCUITS I FEEDERS
0 to 200 Ampere @ $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CANTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liqhtina Retrofit (� $.25 cer Fixture
Hour
Mile
Transformers over 10 KVA $ 20
Transfortner / Power Su I for S' ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ion Tri s $20
1 Investi ative Fee S u r C a r e
Reins ion Fee $20
TOTALFEE
(minimum total fee is $20) � 3 0. 5 0
nnsu�n voa iNSa�cron use od�r
I herebV certi(y that I inspected the electripl inslalla6on described herein on the dates stated:
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D IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspec[ion Required? ❑Yes �No Inspection Other Than Rough-In: � Ready Now ❑Will Call
1 n� 21 � �� You must call the inspedor when ready! Date Ready: I O I z 1� O S
I certify that I am the C}� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at•
INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICIN COPY EB-00001A-15 8.1. 2066