P - 81846REQUEST FOR ELECTRICAL INSPECTION
� ❑ Minnesota Board of Electricity e
1-375-395 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
� www.electricity.state.mn.us
Identity the work covered by this request:
OMIEW ❑ REMODEL ❑ ADDITION ❑ REPAIR XGEL ENERGY SAVER'S SVIIITCM
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si al Standard �$5
0 to 400 Am ere �$25 Su emental Fee �$20
401 to 800 Ampere �$50 Transfortners u to 10 KVA �$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A paratus �$.5D
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNITI
Lots
Recreatlonal
FEES
Transformers over 10 KVA � $20
Transfortners / Power Su 1 for Si ns /0u[line Li htin �$!
ONE 8 TWO FAMI�Y DWELLINGS, EACH UNIT
Inc�udes the Service and/or Power Supply up to 500 Amperas, All
Circuits and Two Inspection Trips Each Dwelling Unft �$80
Additlonal Inspection Trips � $20
�L FEE
is $20)
rc�s�croa use anv
1 hereby certiry that I inspectetl ihe eleclriCal insfalletbn tlescribeG herein on the tlates statetl:
HWGH IN DATE
FlNAIINSPECTpN �!\ _... OATE
� eaa� ms ecnon ��.'si er nnne r-v
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF PL ED WITHIN 18 MO -�--
� � � � ^ FOR OFFICE USE ONLY
1 I�lil IIIiI �10 IN� �(II Ilill IIII�IIi� II(I illl
� ��� r
* 1 3753959* c�O�S�
Request Date: Rough-in Inspection Required? ❑ Yes ❑ Inspection Other Than Rough-in: eady Now ❑ Wili Call
You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
� Mailing
EB-00001
Range Fire No, c:w+nry
ANdKA
Phone
w.
J
Contractor License Number Master Lir�nse
wner erforming ns a aion)
or Owner Pe ortning Installation) Phone
BOARD OF ELECTRICITY COPY INSTfiUCT OP
COPY