P - 78667REQUEST FOR ELECTRICAL INSPECTION
1� 4 2�� ° 3 5 3� Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Sai ul, Minnesqta 55104
(651) 642-0800 TTY/MRS 1-800-62 .elec�ciry.statr.mn.us
❑ NEW ❑ REM DEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy necessary - the wo covered by this request:
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SERVICES I POWER SUPPLIES
0 to 400 Amcere � $25
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus �$.50
3 to 12 Units �$50 Per Unit
Each Addidonal UnR � $25
Pivot Irrina6on Boom
Traffic Signal Standard
Suoolemental Fee � 9
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, fUl
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Ins tion Tri s$20
Investi ative Fee
Reins tion Fee $20 il,,. i
TOTALFEE /�
(minimum total fee is $20) �i C/
TMS MEA FOR MSPECTW lAE Or1Y
I hereby cerGfy Mat I inspec�d the electric� insfaYa6on desaibed herein on Cie da�es sf�d:
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Request Dat� Rough-in Inspection Required? ❑ Yes No Inspection Other Than RougMn: �Ready Now O WNI Call
�� You must call the inspector when ready! Date Ready: �� �� �
I certiy lhat I am ��ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the e�chncxl work at:
�na ��cw ��ns �n nwcR pF �e�ypyy Cppr Bp/Vip pF ELECTRICRV COPV EB-00001Mt4 8.7. 2002 �