P - 76705�. REQUEST FOR ELECTRICAL INSPECTION
2' � J�� 9 4 6 Minnesota Board of Electricity t- I
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1821 UniversRy Avenue Suite S-128, Saint Paul, Minnesota 55104 .. °
, (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -usin8 the back of the white copy'rf necessa - the worlc Covered by this request:
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GENERAL FEES Outdoor L' htin Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere $25 Supplemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transfortner / Power Su I for Si ns I Outline Li htin $5
0 to 200 Am ere $5 ONE & NVO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each Dweiling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 5PVOLTS
Each System Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units !tD $50 Per Unit
s
THIS
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I certifp that I am
=N
ial Unit @ $25
OTHER ADDITIO
�fit @ $.25 per Fixture
Irrigation Boom @ $4f
I Home Park Lots @ $
Vehicle Park SRes C�'
TOTALFE; I � D ��
total fee is $20 f
I hereby certify that I inspected the electrical installa6on described herein on ihe dates stafed:
NOUGNIN ��
FINKINSPECTIqJ � �L -_ DATE
! �--�Z/ /' $ -° c[l
LLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Rough-in Inspection Required? ❑yes o In
spec[ion Other Than Rough-In: � Ready Now ❑Will Call
0 You must call the inspector when ready! Date Ready:
the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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City /
o� 2�.1�-��- j, l�,� �y�'C"�_ -�—f2i cl' �-� _�!
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, c:ompany or ner Performing InstallaUon)
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�trador or Own erfortning Installa6on) Please I
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'ELLO OPY BOARD OF ELECTRICITY COPY
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or
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s including Area Code
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EB-00001A-15 8.7.2004