P - 79299REQUEST FOR ELECTRICAL INSPECTION
��' /��- 5 5 5� Minnesota Board of Electricity -
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYIMRS 1-800-627-3529 www.electricity.state.mn.us
� NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by ihis request:
XGEL EI�;ERGY SAVER'8 Sb�+'i!"CH
GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 40D Am re $25 Su lemental Fee $20
401 to 800 Am e $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIFtCUITS / FEEDERS Transtortner / Power Su I for Si ns / Outline Li htin $5
O to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes ihe Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CircuiLs and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addi6onal Ins tion Tri s $20
Each Svstem Device or Aooaraius (d $.50 Investiqative Fee
fIFAMILY DWELLINGS (PER UNI TOTAL FEE (
3 to 12 Units �$50 Per Unit (minimum total fee is $20) � $20,5Q
E2Ch Add'Itlonal Unit Q$25 rws naen Foa nascec.oa usE aar
I hereby cerUry that I inspecte0 the electrical insfallaUOn described herein on the dates sqled:
OTHER ADDITIONAL FEES (/ �-j
Liohtina Retrofit (� 5.25 oer Fixture 7� ,. _ � G� 7"�� 7 C�/ __
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INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Request Dffie: Rough�n Inspection Required? ❑ Yes Inspedion Other Than Rough-In; ❑ dy Now 0 Will Call
Qgt2� f[j� You must call the inspector when ready! Date Ready:
I certify ihat I 8m the [�.ICENSED CONTRACTOR ❑ COMPAM' ❑ OWNER and hereby request inspection of the electrical work at:
� INSTRUCTONS ON BACK OF YELLOW COPV BOARD OF ELECTRICITV COPY EB-00007A-10 8.1. 21q2