P - 77602REQUEST FOR ELECTRICAL INSPECTION
1� 6 41- 916 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ MODEL ❑ AD ION ❑ REPAIR Describe -using the b of the white copy if necess�y - the work covered by this request:
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ENERAL FEES Outdoor Li htin Standard $1
SERYICES / POWER SUPPLIES __,.- . /A Traffic Sional Standard (a� $5
{� 0 to 400 Am ere S25
401 to 800 Am ere $50
Above 800 Am ere E75
R IFEEDERS
to 200 Am re $5
Above 200 Am e $10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aouaratus � 5.50
2 Units @ $50 Per Unit
Additional Unit @ $25
S ecial Ins ec6on $30 er Hour
Special Inspection � $.31 per Mile
THIS INSTALLATION MAY BE ORD
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Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTALFEE I ���
(minimum total fee is $20) �
iH15 AREA Fq21N5PECipi USE WlV
I hereby ceNy Ih� I inspected the electricai installa6on described herein on the dates sfaled:
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D DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS _ I
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rceques[ u e: Rough-in Inspeclion Required7 l!/Yes ❑ No Inspection Other Than Rough-In: ❑Ready Now 0'Will Call
�� �� You must call the inspeda when ready! Date Ready:
i cerMy ihat I am tt�e f�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec6on of the elecUical work at:
J Site Addess (SUeet Box or Route No.) Zip Code
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Please Provide Two (2) Phane Number(s
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EB-00007M14 8.1.2002
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