P - 77258REQUEST-FOR ELECTRICAL INSPECTION
1� 7 4 6-15 �� Minnesota Board of Electriciiy -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 7TY/MRS 1-800�27-3529 www.electriciry.state.mn.us
❑ +/�❑ MODEL^ �❑ ADDIT �ON� ,,❑� AIR ribe -using the back of ihe white cop if necpss�/' the work covered by this request:
�/ � P�( r � Lx/Lt/ . �/I�I, %/ J/y%Oi /JL� �.N �
� to 400 Am ere S25
401 to 800 Am re E50
Above 800 Am re $75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am S10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � 5.50
ADDITIONAL FEES
Transformers u to 10 KVA $10
Transformers over 70 KVA $ 20
Transformer I Power Su for S' �s / Oudine Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlw Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Ins tion Tri 520
Investi ative Fee
Reins tion Fee $20
TOTAL FEE �
(minimum total fee is $20) � ^
TH5 AREA Fdt MlSPECiqt IISE q1Y
I hereby certity that I inspected tlie ek�chical insialla6on described herdn on tl�e d�s sfaled:
III�I IIII� IIIII I Ni IIIII IIIII II III IIIII I� I� ,:--, f��
17461583 ���`5 ���
Requ t Dale: ugh-in Inspection Required? ❑ Yes ❑ No Inspedian Other Than Rough-In: Ready Now ❑ Will Call
' •�S You must call the inspeclor when ready! Date Ready:
I certiiy that I am the �LICENSED CONTRACTOR 0 COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
.
Job Sile Address (Street. Box, or Route No.l GiN � Zio Code !
� � � � D � �
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Co�nV;ac/ro�r License Number Master Electridan or P�
�� / -.�/T /� p7% �� License Number ,a� �
Coon Raaids. MN
� � . . ��„�-__ t�3 � ?S�7- S7�%�
IN87RUC710N8 BACK OF BOARD OF ELECTRICT' Y EB-00001M14 8.1. 2002