P - 79164� REQUEST FOR ELECTRICAL INSPECTION
� � � � � - � 6 5 � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
] ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCE�, ENERGY SAYER'8 SW4TGH
6ENERAL FEES Outdoor Li htin Standard $t
�i iFS Traffic Sianal Standard na $5
0 to 400 Am ere $25
401 to B00 Ampere $50
Above 800 Ampere @ $75
CIRCUITS I FEEDERS
0 to 200 Ampere @ $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units �$50 Per Unit
E�h Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irtiqation Boom � $40
Transformers
�Transfortner 1 Power Suppl_y for Siqns / OuGine Llghting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Tnps Each Dwelling Unit @ E80
(minimum total fee is $20) � 20.50
THIS ARFA Fqi INSPFCTpi USE p8Y
I hereby ceNry that I inspected the electrical instaNa9on descnbed herein on tfie dMes sta4ed:
INSTALLATION MAY BE ORDERED DISGONNEG
! IIII II I� II 141 I� III II III II IN 1��14 LI IN II III I II�
1R?5�9657
_ _
����
C�/l337� � l
�U
Request Date: Rough-in Inspection Required? ❑ Y� QNo Inspedion Other Than Rough-1�: L'Iheady Nar � WGI Call
� 1 f 1��� You must call the inspecta wFien readyl Date Ready: _
I certify that I am the $I LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby r�equest inspection of Uie electrical work at:
W87RUGTOqS ON BACK OF YELLOW COPY BOARD OF ELECTRICT' COPV EB-00001A-14 8.7. 20U2