P - 75898�
REQUEST FOR ELECTRICAL INSPECTION ��,
�� 8 3 9- 9 4 7� Minnesota Board of Electricity
1821 Universlty Avenue Suite S-128, m P�ul, Minnesota 55104
_ (651) 642-0800 TTY/MRS 1-800-6 � .electriciry.state.mn.us ' •"" "�
Describe - e back of the white copy'rf necessary - ihe work cove y this request:
N/U�T i� � G,o ,�,0 .
GENERAL FEES Outdoor Lighting StandaN @$1
SERVICES / POWER SUPPLIES Traific Sigmal Standard @$5
0 to 400 Am re @$25 Sup lemental Fee @$20
401 to 800 Am re $50 Transformers u to 90 KVA $10
Above 800 Am re $75 Transformers over 70 KVA $ 20
CIRCUITS / FEEDERS Tmnsfnrmar / Pnurur Runniv fnr Rinnc /lliAlinn I InFfinn a, cG
;URS, CIRCUITS OF LESS THAN 50 VOLTS
Each S em bevice or Apparetus Q$.50
ADDITIONS TO THE GENERAL I
iIFAMILY DWELLINGS (PER UNI�
3 to 12 Units Ca4 $50 Per Unit
:5 per Fodure
Boom l�D S40
,LHIS INSTALLATION MAY BE ORDERED bl
1 IUI u�� u� I� III II (�I I� I�I ��II II lu �� I�
18399477
ONE & NVO FAMILY DWELLINGS, EACH UNIT
Indudes the Service andlor Power Supply up to 500 Amperes, Aq
Circuits and Two Inspection Trips Each Dwe�ing Un� (o� $80
Additiomal InsoecGon Trios al� $'ZO
I
TOTAL
to� � IS �
etectrical
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h�e6� on the dams s�ed: I
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ow�u � vare
NECTED IF NOT COMPCETED WITHIN 12 MONTHS
F�P, VFFICE USE ONLY
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"° � Rough-(n Ins�Ction R�uired7 ❑ Yes �No Inspecfton Other Tfmn Rough-In: �Ready Now ❑NM Cep
3 You must call the ins�Or when readyl Date Ready. ��
I certiy that I am e�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Slte Street Addreas ��,
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INSTRUCTION$ ON BAC F W COPY BOARO QF ELECTRICT' COPV
L�er�se Number
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ro(2) Phorre Numbers IncludNg Are�
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