P - 76324� ��� � � � � REQUEST FOR ELECTRICAL INSPECTION
B e� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 5510�
(651) 642-0800 TTYIMRS 1-800-627-3529 www.electricity.st�
Desaibe - g the back of the vuhite copy fi n�ssary - the cover� by this requ�t:
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GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
0 W 200 Am ere $5
Above200Am�ere a�$70
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCURS, CIRCUITS OF LESS THAN 50 VOLTS
Each Addfional Unft @ $25
OTHER ADDRI01
Liahtina Retrofit C� $25 aer Fodure
Transformers over 10 KVA $ 20
TransFortner / Power Suppty for Signs / Outline Lightir�g @$5
ONE 8 Nd0 FAMILY DVdELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circuits and Two InspecUon Trips Each Dwelling Unit @$80
AddiGonal Ins ecfion Trips @ $20
Investigative Fee
Rems 'on F� @ $20
TOTAL FEE �°7✓�'
Iminimum totai fee is $20) � �
I hereby oertfy tl�at I Uispeded fhe elecfinl InstaVetlnn desdbed herein on tlre dates s�ed:
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�pection @$.37 per MAe � �
4LtAT10N MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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q I� REC'D A PR 2 6 2001
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Da�tei: Rough-in Inspectlon Required? ❑Yes ,�lo Inspectlon Other Than Rough-In: ❑ Ready Now�Nill Ced
/ p/`��� You must ca0 Uie inspec[or arhen readyl Date R�dy:
I cer6fy that I am the� LICENSED CONTRACTOR � COMPANY ❑.OWNER and hereby request inspection of the electrical work at
Job Site Street Address City
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Two (2) Phorte Numbers Indudhm Area
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ractw, Company or Owner Perfortning Instella8on)
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�� coor r Oxmer Performing In �noo� Please Provide Two (2) Phone Numbeis Induding Area
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K OF YEL�OW COPY BOARD OF ELECTRICITV COPV EB-00007A-15