P - 76508; - ' REQUEST FOR ELECTRICAL INSPECTION
�� 7 2 6— � 9 8 � 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
❑ NEW EMOD L❑ ADDITION O REPAIR -us' he bxk of the white copy 'rf necessary - Ne xrork covered by this request:
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/ICES I POWER SUPPLIES
0 to 400 Amoere fa? E25
0 to 2(10 Am ere $5
Above 200 Am ere @$10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
2 Unils @ $50 Per Unit
Additional Unfl @ S25
Irtigation Boom
I Home Park La
Vehicle Park Si
Su lement� Fee E20
Transformers u to 10 KVA a$10
Tr�sfomiers over 10 KVA 3 20
Transiormer I Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service ar�dlor Power Suppiy up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips � $20
Investiaative Fee
( TOTAL FE; I �� + �
minimum total fee is $20 ��-t
TItlS NiEAFpt RbPECTOR USE plY
I hereby cerOfy tlwt I inspec0ed Ihe electrical insqNafion daaibed herein on the dates sta0ed:
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�V� �e� Rough-in Inspection Required? Yes ❑ No Irspection Other Than Rough-In: ❑Ready Now � VNII Call
�-� � �� You must call the inspeclor when ready! Date Ready:
I cerMy that I am 1he.�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecti�on of ttie electrical wak at:
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EB-0OOOtM11 8.1. 2002