P - 78734REQUEST FOR ELECTRICAL INSPECTION
1� y� ��- 615 � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�- (651) 642-0800 TfY/MRS 1-800-627-3529 www•electricitystate.mn. us
❑ NEW MODEL ❑ ADDITIO ❑ REPAIR Describe -using the back of itie white copy if necessary - th work covered by ihis request:
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GENERAL FEES Outdaor Li htin Standard $1
SER S I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
40110 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
UITS 1 FEEDERS Transformer I Power Su I fw Si ns I Outline Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes lhe Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two InspecGon Trips Each Dwelling Unit �$80
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 6on Tri s $20
2 Units @
AddiGonal
II�II �IIN IIII) IIII) I�I�I II�II IIIII IIII) �� I�
14286L57
TOTAL FEE �O'�
(minimum total fee is $20)
THIS RREA Fq21NSPECiOR USE pAY
I hereby cerGy that 1 inspecBed the electrical instaNa6on described haein an the dates stated:
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Req te: Rough-in Inspection Required? Yes ❑ No Inspedion Othw Than RougMn: ❑Ready Now � VYII Call
3 O You must call the inspeclor when rea . Date Ready:
I rtifv t I am ihe ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby 2quest inspection of tlie e�ecVical work at:
BOARD OF ELECTRICITY COPV
EB-00001M14 8.7.2002