P - 78933-y 1 c REQUEST FOR ELECTRICAL INSPECTION
� 1— 6 2 9�� 1 V � Minnesota Board`of Electricity -
1827 U' eLsi venu Suite S-128, Saint Paul, Minnesota 55104
(651) 4 RS 1-8 0-627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMO ❑ ADDITION ❑ REP IR De�sc �' sing the back of th ite copy if necessary - the rk cov ed by this request:
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I SERVICES 1 POWER SUPPLIES
2M, COMMUNICATION, REMOTE CONTROL, SIGNALING
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDI710NS TO THE GENERAL FEES
Each Additional Unit @ $25
OTHER ADDITIO�
Lighting Rehofit @ $.25 per Fi�cture
Center Pivot Irriaa6on Boom Ca� S4(
Transformers u to 10 KVA $10
Transformers over 10 KVA .$ 20
Transformer J Power Suppry for Signs I Outline Liqhting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each D�xelling Unit @$80
� TOTAL FE � � �� � I
minimum total fee is $20
THISANEAFq21NSPECTORIISE P�
I hereby certify thffi I inspecOed the electrical installation described herein on ihe dates staled:
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�Q �: Rough-1n Inspec[ion Required7 Yes No Inspedion Other Th� Raigh-In: Ready Now O NMI Call
D' O You must call the inspector when ready! Date Ready:
I certify ihat I am tlre CENSED CONTRACTOR ❑COIu�ANY ❑ 01NNER and hereby request inspecfion of tl1e elechical work at:
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Please Provide Two (2) Phone mber(s) Induding Area Ca
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