P - 78639REQUEST FOR ELECTRICAL INSPECTION
1;_ 4, o�"J � 5 7 6 , Minnesota Board of Etectricity , �:
� 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
�/�'��/ � (651)642-0800TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
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❑ NEW ❑ REMODEL 0 ADDITION REPAIR Describe -using the back of the white copy if necessary - the wo covered by this request:
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GENERAL ES Outdoor Li n Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transformer I Power Su I for Si ns I OuUine Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am e$10 Includes Me Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Cirouits and Two Inspection Trips Each Dwelling Unit @$60 ,�
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additionai Inspection Trips @$20
3 to 12 Units � S50 Per Unit (minimum total fee is $20)
E2Ch Addi60r181 Unit �$25 r�ns na� Fae i�craa usE aar
I hereby cer6ry that I inspecled tlie ekctrical installation desaibed herein on the daBas st�d:
OTHER ADDITIONAL FEES
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1Y BE
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❑ COMPANY ❑ OWNER arb hereby request inspection of ihe electrical wak at::
INSIRUCTIWIB ON BACK OF YELLOW COPY
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BOARD OF ELEC7RICRV COPY
EB-00001A-14 8.7.2002