P - 78175.�
.1-��2-536 7�
t
❑ NEW ❑ REMODEL 0 ADDITION
' s
GENE L FEES
800
� Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or A�oaratus (d 5.50
3 to 12 Units
Each Additio
Lighting Retrofit
Center Pivol Irri�
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of ElecVicity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
R Describe -using the back of the white copy if necessary - the work covered by this request:
Traffic Si nal Standard �$5
Su demental Fee $20
Transformers u ta 10 KVA $10
Transfortners over 10 KVA $ 20
Transformer I Power Su I for Si ns / OuUine Li h6n $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Txro Inspec5on Trips Each Dwelling Unit @$BO
Additional Insoection Trios (d $20
TOTAL FEE I I
(minimum total fee is $20) � �Q � ��
iM15 AREA FOR INSPECTpt USE OIIY
I hereby cer6fy that I inspecled the electric� installatan described herein on the dates stafed:
arate Bondin Ins tion $20 .�— O
S ial Ins tion $30 er Hour E%RREDI onrE
S ial lns tion y.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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1 5 8 2 5 3 6 7
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Request Dffie: Rough-in Inspection Required? ❑ Yes No Inspeclion Other Than Rough-In: ❑Ready Mrll Cai�
�'�' Qi 7 Q You must call the inspector when ready! Date Ready:
I certify that I am the �LICENSED CONTRACTOR � COMPANY � OWNER and he2by request inspection of ihe electrical woric at::
Job, S/il�e Address (Stree4 Box, a Route�°
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BOARD OF ELECTRICT' COPY
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License Number
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Ph ne (s)
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EB-00001A-14 8.