P - 80090�` REQUEST FOR ELECTRICAL INSPECTION
1-` 6 q, ���J 4 8 � Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651 � 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.ecs
❑ NEW ❑ REMODEL ¢lcOblTfQ1V1 ❑_ REPAIR Describe -using th� back of the te py if necessary - the work covered by this request:
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Exh System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Addifional Unit @ $25
Center Pivot
� THIS INST/ILLATION MAY BE ORDfRED DISCONNI
I IIII II III I� i{{ II II� {I III II III II (II I{ III ��( NII.
2 4
Traffic Si nal Standard $5
Su lemental Fee $20
Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Indudes tl�e Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$60
( TOTAL FE j I � f"�` �
minimum total fee is $20 (�
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I hereby cerGry that I inspecled the ekctrical instaAa6on described haein on the dates sf�ed:
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ReQuesl Date: Rough-in Inspedion Required? Yes ❑ No I�upection Other Than Rough-In: y Now O Wil Call
� �Q You must call the inspeclw when ready! Date Ready.
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site A/dress (Street,�px, of ROUIE/ t) _ 'n�� / I e %') � � �e � / r, �
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IN87RUC710N8 ON BACK OF YEIJebW COFY BOARD OF
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Please Provide Two (2) Phone Number(s) I
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EB-00001M14 - 8.1.2002