P - 76692�` REQUEST FOR ELECTRICAL INSPECTION "��•
� 1� O��J � 4 5 3� Minnesota Board of Electricity �-;
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
C� r, n c r,� �h 0`'
GENERA fEES Outdoor Liqhtinq Standard (�a. $1 �_
Above 800 Am ere a$75
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CANTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liqhtinq Retrofd (c� $.25 cer Fi�ure
Hour
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18204537
Transformers over 10 KVA $ 20 .
Transformer I Power Supply for Signs / Outline Lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE I i // �D
total fee is $20) �5F (.
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�ereby certi(y that I inspeded the el ' s Ilation desaibed herein on the dates stated:
UGHIN � DATE
3- Zjz.� r
�4LINSPECTION DATE
(PIRE�I NOONEO }Da,IE /
� �f�' llG�°�`
�TED IF NOT COMPLETED WITHIN 12 M NTHS
�vo � -oa�i�
Date: Rough-in Inspection Required? �Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
�_ � l� , You must call the inspector when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY �bWNER and hereby request inspection of the electrical work at
INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPY EB-00001A-15 8.1. 2004