P - 76140REQUEST FOR ELECTRICAL INSPECTION ���`'
2� o�, o� 7°� �� Minnesota Board of Electricity •
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.ur
Descritre -using the badc of the white copy if ne�ssary - the work covered by this request:
/ POWERSUPPLIES , , I I Traffic
:ui i� i rttutrts Transtormer/ Power Su I for Si s/ Outiine ' $5
0 to 200 Am $5 ONE & TN/0 FAMILY DWELLINGS, EACH UNR �
Above 200 Am re$10 Includes the Service and/or Power Suppiy up to 500 Amperes, All
ZM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circufts and Tavo InspecUon Trips Each Dwe�ing Unit @$80
:UITS, CIRCUITS OF LESS THAId 50 VOLTS Addi�onal Ins 'on Tri $20
Each System Device or tus @$.50 Im� ative Fee
ADDffIONS TO THE GENERAL FEES Reins 'on Fee $20
TIFAMILY DWELLINGS PER UN TOTAL FEE $ rj �
3 to 12 Uniitss @$50 Per Un(t (minimum total fe� is $ZO)
Each Additional Unit @ $25 TM���+����Y
OTHER ADDITIONAL FEES �� �
Lightin Retrofrt $.25 r Fixlure � hereby cerurythat � inspeaed the insmnatlon desaibed herefi on nm daoes a�ed:
CeMer Pivot Irriaation Boom C� S40 "� a �. �re
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Hour
rOF O�F:.r= USE oNL7 ��/ C
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I�'$-8_06 I Rough-In I�pectlon Requlr�? $]Yes ❑ No Inspecdon Other Than Rough-In: ❑ Ready Now $�WiA Call
You must ca➢ the inspector when readyl Date Ready.
I certidy that I am the � UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request ins�ction of the eledrical work at