P - 78253�/� REQUEST FOR ELECTRICAL INSPECTION
1� 412 ���� �F Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651)642-08001"TY/MRS 1-800�27-3529 www.electriciry.state.mn.us
O NEW O REMODEL DDITION ❑ REPAIR Describe -using the bxk of the white copy 'rf necessary - the work covered by this request:
w�nc- �.�.�n��7�d�v �-Ri'D��
SERVICES I POWER
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Each Addi6onal Unit @ $25
OTHER ADDITIONAL FEES
LighGng Rehofit � $.25 per Fixture
Center Pivot Irriaation Baom � 540
Su lemental Fee $20
Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / OuUine Li htin $5
ONE � TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unil @$80
Additional Insoection Trios Cd $20
TOTAL FEE 50
(minimum total fee is $20) �'�
THIS AREA Fqt INSPECiOR USE ONLv
I hereby certiry that I inspected ihe electric� inst�lation described Irerein on the dates stated:
�vl
I��II II II� II II� II II) II III �� I II I�� � 111 � I�I l O`�
�� ����� ��-
1 4 1 2 8? 1 4
��/�nd 4�`1 y �D��D
Request Date: Rough-in Inspection Required? Yes ❑ No Inspedion Other Than Rough-In: ❑Ready Now Will Call
—D y Yau must call the inspecta when ready! Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electriql work at::