P - 77291REQUEST FOR ELECTRICAL INSPECTION
1� 6 7 9- 3 3 8� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55704
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW EMODEL ❑ ADDITION ❑ REPAIR Describe -using Me baok of ttie white copy 'rf necessary - the work covered by ihis request:
GENERAL FEES Outdoor ' htin Standard E7
SERVICES / POWER SUPPLIES Trafic S' nal Sfandard E5
0 to 400 Am re;25 Su mental Fee $20
401 to 800 Amcere � E50 T.ao�r�,�o� ��„ �� t n�cve ua e�n
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Anoaratus 0 5.50
3 to 12 Units @$50 Per Unit
Exh Additional Unit � $25
�Transfortners over 10 KVA �0 S 20
Tra�sfortner / Power SuDdY fa Signs I Outline �qhtinq ES
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 Dwellirg Unit � E80
( TOTAL FE; �^ D ��
minimum total fee is $20 �[ �
TItlS AREA FOR IIISPECTOR USE 0ldv
I hereby ceAfy that I inspecBed Ihe electrical instaY�on described herein on Ihe da�es sfaBed:
�'
Hour
(I� IIIII IIIII IIIII IIIII II III IIII) �II�I �� I� i �'j
16793382 �v �����
R��� �e� Rough�n Inspection Required? ❑ Yes �.Ib Inspedion Other Than Rough-In: �dy Now � y1�ll Call
��� �%s You must call the inspector when ready! Date Ready:
I certify that I am ihe �IICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
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E&00001M1I 8.1.2002