P - 76434REQUEST FOR ELECTRICAL INSPECTION ��
1-787-929 7 Y �J.:'�
❑ Minnesota Board of Electricit ;r �',
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627-3529 w�rx�.electricirystale.mn.:�s
Descri�e -U�ing the back of the white copy if ner,es,saf�.- the �v�,�Y e g,by�i�i�s Se�qugst; ,..,
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SUPPLIES
to 400
IMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS Of LESS THAN 50 VOLTS
�ystem Device or Apparatus @ $.50
ADDITIONS TO THE GENERAL FEES
$50 Per Unit
Unit @ $25
OTHER ADDITIONAL FEES
an $.25 cer Fixture
Hour
Outdoor Lighting Standard @ $1
Traffic Signal Standard $5
Supplemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWE�LINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investigative Fee
Reinspection Fee $20
TOTAL FEE :'i":,, r� yi
(minimum total fee is $20)
THIS APEA FOR INSPECTOR USE ONIY
I hereby certify that I inspected the electrical installation descnbed herein on the dates stated:
�OUGMIN DATE
'INALINSPECTION DAiE
�' 2 �—��
INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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. i„ �, Rough-in Inspection Required? ❑Yes �]No '�, Inspection OtherThan Rough-In: Q�Ready Now �Will Call
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�• __ _� You must call the inspector when ready! i Date Ready:
I certify that I am the L'�j LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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�. Owner/OGCU ant Name P wo 2 Phone Numbers Includin Area Code
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�� EleGtric,�l Utilit �, Electrical Utility Address
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' GoMractor / Com an Name �----
, P x, _ � Contractor License Number Master Elechician or Power Limited Techni
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� Ma�hrl�Address,SContractor Com any or Owner Performiny Installation)
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���r�zed 5 nature (Contractor or Owner Performing Installation) � Please Provide Two (2) Phone Numbers Indudmg Area Code
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INBTRUCTIOqS ON BACK OF YELLOW COPY _BOqRD OF ELECTRICITY COPY � EB-00001A-15 A.1.