P - 77472REQUEST FOR ELECTRICAL INSPECTION �
1����- 9 01 6 Minnesota Board of Electricity ''�p`_
❑ 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 � _
(651) 642-0800 TTYlMRS 1-800-627-3529 tirwir.electricity.s�ate.mn.us
sing the back of the w,hite copy if necessary - the work cove �ed by thi req�u�st: _,
r::�.-I-�L_ Cik��;G� •'.i��1v_}i';.? ;�i�IC:!-I
' `/GENERAL FEES Outdoor Lighting Standard @ $1
i POWER SUPPLIES Traffic Signal Standard @$5
i0 Ampere $25 Supplemental Fee $20
gpp qm re $Sp Transformers u to 10 KVA $10
800 Am re $75 Transformers over 10 KVA $ 20
FEEDERS Transtormer I Power Su I for Si ns I Outline Li htin $5
10 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
00 A AII
Ahove 200 Am re $10 Includes the Sernce andlor Power Supply up to 5 mperes,
A�ARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20
EaCh System Device or Apparatus @$.50 Investigative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee @$20
2 Units @ $50 Per Unit
Additlonal Unit @ $25
OTHER ADDITIONAL FEES
rw ReVOfit (c� $.25 per Fixture
$ ial Ins chon @$.31 per Mile �
tHl� IAJ8TALLATION MAY BE ORDERED
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TOTAL FEE :�; j _ _�r':�
total fee is $20) � �
that 1 inspected the electrical installation descnbed herein on the dates stated:
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JNECTED IF NOT COMPLETED WITHIN 12 MONTHS __ ____�
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� ��� � � Rough-in Inspection Required? ❑ Yes � No �', Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
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. 1 You must call the inspector when ready! ' DI ate Ready:
I caartify that I am the �] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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'� Job Sit9 Sheet Address .. t_ .. - ---- -- City y� ji: y 'a �_ � �T . .'`�� _� `<<� —' `-
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'. Townsh'ry � Section , Range - TFire No. I Counry
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I' Owner/Occupant Name �-�Please Provide Two (2) Phone Numbers Including Area Code
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, ElecVical UUlity �lectriral Utility Address
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Conkactor / Company Name Contractor License Number � Mas[er Electrician or Power Limited Technic
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� Madmg Address (Contractor Company or Owner Performing Installation)
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p�j��p� and $i�ontractor or Owner Performing Installation) l Pl)ease Prowde Two (2) Phone Numbers Including Area Code
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..�ere,�r e nu o•rr nc vei i nw rnDV Rf�ARfl nF FI FCTRICITV COPY EB-00001A-15 _ 1.