P - 78744REQUEST FOR ELECTRICAL INSPECTION
1� 4 3 7- 714 ❑7 Minnesota Board of Electricity
G/�i y.., r��, �/ 1g21 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� � ( 6 5 1) 6 4 2- 0 8 0 0 T' f Y/ M R S 1- 8 0 0- 6 2 7- 3 5 2 9 w w w•electrici ry.state.mn.us
❑ NEW q REMODEL ❑ ADDITION REPAIR Describe -using the back of the white copy f'rf ece�ssary - the wo r k covere d by t his reques t:
l'1°%/� � �r/� �% �f;�s��/�G�'f��..�
GENERAL FEES Outdoor Li h6n Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus � E.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS (PER UNIn
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEE:
Lightinq Retrofit � E.25 per Fixture
� Cenier Pivot Irtio�on Boom @ S40
ONE 8 TWO FAMILY DWELLIN�s, tnc;r+ urvi i
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Grouits and Two Inspec6on Trips E�h Dwdling Unit Q S80
Additional Inspection Trips � $20 _
� . .. .. � _ _
TOTAL FEE I
(minimum total fee is $20) � �d
TMIS AREA FOR IILW ELTp2 USE OKY
I hereby cerEry thaa I inspecoed Ihe electrical instalW6on deuribed her� an Ihe d�es sfa�ed:
3� z�'a3 I
I �Il� (�III �I (I� ��III I4III (I (�t �I II� II III NIA ��
1 4 3 7 7 1 4 7
I��%i 36�,�0 ,
Requ�i� e: Rough-in Inspedion Required? ❑ Yes No Inspection Other Than RaugFNn: ❑Ready NaYV Wfll Call
cJ �� � You must call the inspedor wFien ready! Date Ready.
i cefify tliat I am tlie LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he�eby request mspection of the electrica� worlc at:
�� 02
;� _ . . , .-
.i , _ � �
oF �cTwcm
, � �. :,�
� ��
i�i �
���__ -.:
EB-00001M14 8.1.2002