P - 78737REQUEST FOR ELECTRICAL INSPECTION
1�„ ��� �� 0 1 � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW ❑ REMODEL DITION ❑ REPAIR Describe -using the bac the white copy if necessary - the work covered by this request:
1 .� � �-� .
GENERAL FEES utdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su emental Fee $20 �
401 to 800 Amcere (d $50 Transformers u to 10 KVA $10
COMMUNICATION, REMOTE GON I KUL
S. CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units (a� $50 Pei
Each AddiGonal Unit @ ;
Mile
Ilil ll ih l l ln ll ia ll lll Il lll ll lll ll lll a� l�
.L4288013
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes� All
Grcuits and Two Inspection Trips Each Dwetling Unit �$80
Additional Ins 5on Tri $ZO
Inves' a6veFee
Reins tion Fee $20
TOTAL FEE ,�
(minimum total fee is $20)
THIS /JiE�:012IlEPECTOR USE QlY
I hereby certify tliffi I inspecfed Ihe electric� instalabai desaibed herein on the dabs sf�ed:
R�,* M MTE
FIWLL HSPECTION MTE
� � - -�1 Z � � D�
�o,�euoor�o ° w�
°_CTED IF NOT COMPLETED WITHIN 12 MONTHS __
� ,�
(��� a� S
Requ t Date: Rough�n Inspection Required? ❑ Yes No Irupection Other Roug In: Ready Now ❑ WNI Call
- Q You must call lhe inspecta wh� readY! Date Ready: �
I certiiy that I am tt�e ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work ati:
YELLOW COPY
gpARp OF ELECTtICRV COPV
EB-Op001M/1 8.7. 2002