P - 77147REQUEST FOR ELECTRICAL INSPECTION ��
1� 4� f'"�' � L� �' Minnesota Board of Electricity � ;�
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �`
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us ��;;�`�
)escribe -using the back of the white copy if necessary - the work covered by this request:
�.�t.) � K �rh � c.�.
GENERAL FEES Outdoor Liahtina Standard C�a $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard @$5
0 to 400 Ampere $25 Sup lemental Fee $20
40t to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transfortner / Power Su I for Si ns / Outline Li htin $5
0 to 200 Am ere $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20
Each S stem Device or A paratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee a(� $20
Center Pivot Irrigation Boom �
Manufactured Home Park Lots
TOTAL FEE ��
total fee is $20) �n . `�
I herebvi certrfv thal I inspected the electriral inslalla6on descnbed herein on ihe dates slated:
�2—i° �` �
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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I IIII II III II III II rli II III I� II I III II III �� I�
18463299
ua[e: Rough-in Inspectlon Required? ❑ Yes �[No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
� � You must call the inspector when ready! Date Ready: '��� �
I ceRify that I am the �'LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at