P - 77577� REQUEST FOR ELECTRICAL INSPECTION �
1� 8 6 8� 3 1 7 � nesota Board of Electncdy �- �
� 8 Universdy Avenue Sude S-128, Saint Paul, Minnesota 55104 �� �
� ) 642-0800 TTYIMRS 1-800-627-3529' www.electriciry.state.mn.us
Describe -using the the whiJq copy ry� the wprkpovered is reguest: •
1/ t/C L/ V l_ �D� �j/ D�G
GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re$25 Supplemental Fee @$20
401 to 800 Am re $50 Transfortners u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
IRCUITS / FEEDERS Transformer I Power Su I for Si ns / Outline Li htin $5
0 to 200 Am ere $5 ONE & TWO 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 Dwellirg Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20
Each System Device or Apparatus @$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 Units @$5o Per Unit (minimum total fee is $20) ,
I Home Park
Vehicle Park
ec�al Inspection @$.31 per Mile �
INSTALLATION MAY BE ORDERED DI
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18683177
I Date:
I certify that I am
Utility
r / Company
I hereby certify ihat I inspeded ihe electrical installatian described herein on fhe dates stated:
RWGH IN DATE
INAL INSPELTI pp� /
�� oy � u. -o�
IF NOT COMPLETED WITHIN 12 MONTHS
, � .,b .. .
Rough-in Inspedion Required? ❑ Yes � Inspection Other Than Rou ❑ Will Call
You must call the inspector when ready! Date Ready:
VSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby reques ins ' n of the electrical work at
c
' n Range Fire No. Counry
Please Provide Two (2) Phone mbers Including Area Code
/
E ity Address
Contrector License Number Master ElecVician or Power Limited Technician
/ /f �.%-� /� /' n . A _/�► �% /il� License Number
, yompQny or
a.� ����� u� vMq�e' renormin instan � �,rlease Nro - Two (2) Phone Numbers Including Area Code
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ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY EB-OOOOtA-75 e t �nna