P - 78869� REQUEST FOR ELECTRICAL INSPECTION` ,
1— 4, s.! 1� 9 3 6 � Minnesota Board of Electricity �� V���j'�� 1^� -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 4
, S � (651) 642-0800 TTY/MRS 1-800-627-3529 www.ele ric' �.mn.us
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❑ NEW ❑ REMODEL ADDITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the red by this request:
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traific S' nal Standard $5
0 to 4D0 Am re $25 Su lemental Fce $20
401 to 800 Am re $50 Tr�sformers u to 10 KVA $70
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I Power Su I for S' ns / Outline L' htin $5
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
, Above 200 Am re$10 Ir�cludes the Service �d/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Exh Dwellirg Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or atus $.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
Center Pivot
Hour
I��� IIIII III� �I11� III�� I�III �) III IIIII I�� I�
14519367
{Y1 ` ` yy� TOTAL FEE r *-�
��� r�mi um tohaf fee is $20) a"'�,��lJ�
THIS NlEA FOR INSPECTOR USE p1v
I hereby cert�y thffi I inspec�d the Ne�y�j�stalla6on described hereip .
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I Rw�� �e: Rough-in Inspection Required? ❑ Yes �NO Ins
peqion OtherThan
�— � 4� Ya must call the inspectar when readyl Date Ready.
I certi(y tl�at I am the ❑ LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and herebv n
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I.wmaizao � nawre �wm2cror� c:ompany or
INSTRUCTONS WI BAGK OF YELLOW COPY �
BOARD OF ELECTRICRY COPV
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07� ;.�D
-In:� eady Now ❑ Will Call
inspection of the electrical work at:
ip Code
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EB-0OOO1M14 8.1.2002