P - 77578REQUEST FOR ELECTRICAL II�,�PECTIO )
1� 7 4 7- 6 6 5� Minnesota Board of ElecVicity ���5 ' ���,�j
1821 University Avenue Suite S-128, aint Paul, Minnesota 5
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electri
❑ NEW ❑ REMODEL ❑ ADDITIO R PAIR Describe -u ng the back of the white copy'rf necess - the work by
l�i� �1� C.
GENERAL FEES Outdoor Liahtino Standard _$1
to 800
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 �012 Units @$50 Per Unit
Exh Additional Unii @ $25
OTHER ADDITIONAL FEES
LighGng Retrofit @ $.25 per Fi�Rure
Center Pivot Irriaation Boom � 840
nn.us
mis reouesc:
Transformers u to 10 KVA $10
Transfortners over 10 KVA �$ 20
Transfortner I Power Supply for Sipns / Outline Lightinp @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up l0 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Ins ection Tri s $20
Investi ffiive Fee
Reinscection Fee (a� $20
(minimum total fee is $20) � �
iH15 AREA Fpt INSPECTOR U
I hereby certify that I inspected the electrical installa6on described
Illll IIII� IIIII II�II II�II IIIII (IIII II�II N� I�
1 7 4 7 6 6 5 6
Roughin Inspeclion Required? ❑ Yes r�o i„spec�o� ane�
You must call the inspecta when ready! Date Ready: `
that I am the ICEI�SED CONTRACTOR ❑ COMPANY ❑ OWNER and hen
Address x, a No.) City �
� � �� ��- �'�'�,�t
� 7�ll�r� ��t�t
Power Supplier r Supplier Address
Can / ,pa"y� 1.--! �� ConvactorLic
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Mai mg dress ( actor any or er Performin nstallaGon) �
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Auth re ( r, pany or Own Perfortning Installation)
IN8TRUCTONS ON BACK LLOW COPY BOARD OF ELECiRICITV COPY
Z2-�Q �
n j�toygh-Jh:�/� Now Ll Will Call
/ �/
request inspection M tlie elecfical work at:
Number
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EB-00007A-14 8.1.2002