P - 77572c /� REQUEST FOR ELECTRI�{ AL If�SPECTION ��"�,
1' 8 C-j 8� 3 5 2 !�F Minnesota Board of Electricity aiQD� - a(% �� ��+ °�
❑ '�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 5 04 �`
. (651)642-0800TTY/MRS 1-800-627-3529 wwrv.electricily.state.mn.us ��
Describe -using e a 9f Jpe y�hite copy i ecessary • the work covered by this request:
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GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Ampere @$25 Supplemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
IRCUITS I FEEDERS Transformer / Power Su I for Si ns I Outline Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unii @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional ins tion Tri s $20
Each System Device or Apparatus @$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins tion Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE O_�
3 to 12 Units @$50 Per Unit (minimum total fee is $20)
Each Additional Unit @ $25 rHisnaEnFOair�saECTOauseoruv
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irrigation Boom al� $4(
5 cial Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED I
I I�II II III II I�I (I �II �� (�) II III �I �II �I II) �� I I�II
18683524
I hereby certify that I inspeded the elecirical installation described herein on the dates sWted: �
7-z s ��
E%PIRED�ABANDONED DAiE
ECTED IF NOT COMPLETED WITHIN 12 MONTHS
Date: Rou h-in Ins ection Re uired?
g p q ❑ Yes � Inspection Other "(
You must call the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby
Name
�
� `� /
Utility Address
Fire No.
�Jow O W ill Call
of the electrical work at:
/
Master Electrician or Power
License Number
Area Code
„ucrror a gn�ure rac[or or vw er rert i g allation) v Please Provi Tw bers Including Area Code
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INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRIGTY COPV EB-00001A-15 e.i. 2004