P - 78439REQUEST FOR ELECTRICAL INSPECTION
1� 4 9 0� V O� � Minnesota Board of Electricity - _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
• (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
NEW ❑ REMO�D L O ADDITION ❑ REPAIR Describe -using the back the whit opy if necessary - the work covered by this ues �
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GENERAL
SERVICES /
0 to 400
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL
3 to 12 Units
CRntef
1
' Traffic Si nal Standard S5
Su lemental Fee S20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li h6n $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$60
TOTAL FEE /JO , �j�l
(minimum total fee is $20) o< <J
THIS MEA Fd31N5PECipt USE ONLV
I hereby ceitify Mat I inspected the elecbical installa6on described herein on Me dates st�d:
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( I��I �I III II III II I�I I) III I� III I) �I II (I) �III I� �,�'
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I ceAify that I am the
CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
BOARD OF ELECTRICITV CAPV
EB•OOOOtA-14 8.1.2002