P - 84406REQUEST FOR ELECTRICAL INSPECTION
1��/� �-� 5 6� Minnesota Board of Elecficity -
`t 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. (651) 642-0800 T'fY/MRS 1-800-627-3529 www.electriciry.state.mn.us
0 NEW REMODEL ❑ ADDITION 0 REP Describe -using the back of the white copy rf necessary - the work covered by this request:
CES / POWER SUPPLIES
to 400 Amcere (a� $25
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
E�h Additional Unit @ $25
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriaation Boom na S40
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Su lemental Fee $20
Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transfortner / Power Su I for Si ns / Outline Li htin $5
ONE & TW FAMILY DV�ELUNGS, EACH UNIT
Includes fhe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dvrelling Unit @$80
Addi6onal Inspection Trips @ $20
Invesliaative Fee
(minimum total fee is $20) u
iH15 ARFA Fqi �NSPECiOR USE OKY
I hereby cer6y that I inspected the elechical installa6on described herein on Ne dates stated:
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Request oate: � Rough-in Inspection Required? ❑ Yes 4j No Inspeclion Other Than Rough-In: ❑Ready Now � Will Call
(�+0' You must call the inspecta when ready! � Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::