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P - 78116Cc REQUEST FOR ELECTRICAL INSPECTION 1� J� U�- 912 � Minnesota Board of Electricity - 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ❑ NEW REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of tt�e white copy rf necessary - the work covered by this request: Convert overhead residential service to undergrou GENERAL FEES Outdoor Li htin Standard E1 SERVICES I POWER SUPPLIES Traific Sianal Standard � ES _. � 0 to 400 CIRCUITS I FEEDERS 0 to 200 Ampere � $5 Above 200 Ampere (D$10 ALARM, COMMUNICATION, REMOTE CONTROL CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each Svstem Device or Aooaratus � 8.50 Additional Unit @ Boom Fbur Su �lemental Fee $20 Vt� ' Tr�sfortners u to 10 KVA � E70 Trarisformers over 10 KVA $ 20 Transformer I Power Su for Si ns I Outline Li h6n $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service andlor Power Supply up to 500 Amperes, All Circuits and Tv�ro Inspection Trips Each Dwelling Unit �$80 Fee (minimum tofal fee is $20) � $30. 50 iH15 N2EA FOR INSPECTpi USE OKv I hereby cer6ry Mat I inspecBed the electrical inst�la6on described herein on the dates sfated: INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN ���85i IIIUIIIIIIINIIIIIIIiINlillllillllllllh�l� � ^ 1 5 6 2 9 1 2 4 ��Q�.,�/� �� 30•50 - �4�< <+e�e� Rough-in Inspecfion Required? LJ Ves l� No Inspectiai Other Tha� Rough-In: ❑Ready Now � Will Call 9� �% � Q�f You must call the inspecta when readyl Date Ready: I certi(y that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: INS7RUCTONS ON BAGK OF VELLOW COPY BOARD OF ELECTRICIT' COPV E&00001A-14 8.1. 2002