P - 78346..
REQUEST FOR ELECTRICAL INSPECTION
1����- 217 � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
C�(..��q � (651) 642-0800 TTYlMRS 1-800-627-3529 www.e[ectricity.state.mn.us
❑ NEW �EMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
�.� l"/l���Sr,n t�5�--77�. 7sf�s
SERVICES I
IMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERAL FEES
FAMILY DWELLINGS (PER UNIn
to 12 Units �$50 Per Unit
ach Additional Unit � $25
Lighting Retrofit @ $
Center Pivot Irtigatio
Manufactured Home
IIII II �) (I III O III I) III II I�� II II� II III � I� I�
1 5 1 2 2 1 7 9
Traffic Si nal Standard $5
Su lemental Fee $2f1
Transfortners u to 10 KVA $10
Transfortners over 10 KVA 5 20
Transformer I Power Su I for Si ns I Outline L' htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlw Power Supply up to 500 Amperes, All
Cirouits and Txro Inspection Trips Each Dwelling UnR �$60
( TOTAL FE j I d7�
minimum total fee is $20
THIS AREA FOR INSFECTpi USE OKY
I hereby certiry that I inspected the electrical installa6on despibed herein on tlie da�s stated:
/Y!.(' � �?_03
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�Q� �e� Rough-in Inspection Required7 ❑ Yes �No Inspedion Other Than RougMn: �Ready Naw� Will Call
�/��/� � You must call the inspecla when ready! pe� ►�y:
I certify that 1 am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby iequest inspaction of tl�e electrical wo�c at:
INS7RUC710N8 ON BACK OF YELLOW COpY BOARD OF ELEC7RIqTY COPY EB-00001M74 8.7. 2002