P - 79770REQUEST FOR ELECTRICAL INSPECTION ._�.
Minnesota Board of Electricity "�
• 1-396-549 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642-OS00 TTY/MRS 1-800-627-3529
www. electricity. s ta te. mn. us
Identity the work covered by this request:
U NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR �L ENEROY SAVER�S SWITG'I
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Sianal Standard �$5
B00 Ampere �
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A aratus (� $.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS (PER UNIn
Lots � �
$itBS �
Transfortners u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortners / Power Supply for Signs / Outline Liqhtinq �$5
ONE $ TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppry up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips � $20
Investi ative Fee
Reinspection Fee � $20
TOTAL FEE
FOR INSPECTOR USE ONLY
1 hareby certify ihat I inspected ihe electrical instellation d�eribed herein on ihe tlates steted:
170UGH IN MTE
FINRL IN$PEC710N �ATE
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� FOR OFFICE USE ONLY
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Reque Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-in: Ready Now ❑ wll Call
You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Jo6 Addres��tr�t, Bo���� �R NE �� FRIIX.EY Zip Code ��.�
Section Township Range Fire No. Counry
°`�°��EEhIWALD JUDY ,) Phone
Power Suoolie[ �� Address
]R:EL
Electric�l GpnWcirK /,Cyay�nu,tdypyqR���� Cqntrector LiGpD�eJW�wbec Master License Number
�'IVI'YI CI C�sfl"(I\ib4J W1 W00,9
Mai�ing A��r�n�+ ; ��y�r��N 55114
Authoriz ' ature (�tract mi�anyor Owner Perfortning Installation) Phone �1 ���,�
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EB-OOOOtA-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY