P - 78009REQUEST FOR ELECTRICAL INSPECTION
,.� � J U�- 7 6 7� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saim Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW 0 REMODEL DDITIQN 0 REPAIR Describe -using the a�ef ihe te copy if necessary - the work covered by this request:
GENERAL
0 to 400 Ar
401 to 800
ALARM, COMMUN�CATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit
FEES
Center
S ecial Ins ection E.31 er Mile
THIS INSTALLATION MAY BE ORDERI
,
ransfamers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs I Outline Lia_hting @ E5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Txro Inspection Trips Each Dwelling Unil @$80
Additianal Inspection Trips � $20
Investiaative Fee
TOTALFEE
(minimum total fee is $20) %"�J
TMS�RE�FORINSPECi0RU5E ,
I hereby cerfily that I inspected the electrical insf�lation described herein on the dates stated:
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VYITHIN 12
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I certify that I am the
Job Sile Address (Stre
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Roughin I�spedion Required? ❑ Yes ❑ No Inspedion Other Than Raugh-In: Ready Now O Will Call
You musl call the inspecta when ready! Date Ready:
NSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical worlc at:
te No.) City.�.�'�� Zip Code /'
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Maste� Fle�trician or
License Number J�
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INSTRUCTONS ON BA OF VE / BpARp OF ELECTRICT' COPY T EB-00001A-14 8.1. 20D2