P - 78924REQUEST FOR ELECTRICAL INSPECTION
1� 6 5�� 0 8 8 � Minnesota Board of Electricity -
1821 University Avenue Su' -128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/M - -627-352g www.electriciry.state.mn.us
O NEW ❑ REMOD ADD N 0 REPAIR Describe -us' g the b� of ite copy if necessa - the work covered by this request:
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SERVICES I POWER SUPPLIES
� � ��� I ransformers over 10 KVA $ 20
' FEEDERS Transfortner / Power Su I for Si ns / Outline Li htin $5
10 Am re b5 ONE & TWO FAMILY DWEILINGS, EACH UNIT
200 Am e$10 Includes ihe Service andlor Power Supply up to 500 Amperes, All
)MMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspec6on Trips Each Dwelling Unit � S80
CIRCUITS OF LESS THAN 50 VOLTS Addi6onal Ins tion Tri $20
iystem Device or Apparatus $.50 Investinative Fee
3 to 12 Units @
Each Additional
Fixture
l illi II Iil II Iil II iil Ii lll il lll II III II III �� I�
16510885
. IN87RUCTONB ON
TOTAL FEE
(minimum Wtal fee is $20) ��_�
iHIS MFA FOR INSPECTOR USE O�dY
r I I hereby certiry that I inspected the elecbic� insfalla6on �SCribed I�e2in on the 0� sfaBed:
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CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricxl work at:
h[MriD OF ELEC7RICT' COPY
EB-0OOOtM74 8.1.2002