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P - 77768REQUEST FOR ELECTRICAL INSPECTION 1- 6 3 4- 3 61 � Minnesota Board of Electriaty 1821 University Avenue Suite S-128, Sairrt Pat�. Minnesota 55104 (651)642-0800111fIMRS 1-800�27-3529 www.electricity.state.mn.us � NEW MODEL O ADDITION ❑ REPAIR Describe -using the badc of the white copy 'rf necessary - the woric coveied by this requesC ; oCi -� �_� � I Supplemental Fee �; �— Trais(amers uo to 10 5 " ONE & TWO FAMILY DWELLINGS, EACH UNIT S10 Includes the Service andlar Power Supply up to 500 Amp�es, All N, REMOTE CONTROL, SIGNALING Cirouitc and Two Inspection Trips Each Dwelling Unit � S80 LESS THAN�p Y4�TS _ Additional Inspection Trips @ S20 fIFAMILY DWELLINGS PER UNI TOTAL FEE 3 to 12 Units @ E50 Per Unit (minimum total fee is $20) 7(Q � E2Ch Addi6onal Unit � E25 *�us ru�, Fa+xavECroa us� aar I IKreby certfy tliat I inspecled tl�e dectital i�faNaYOn destribed haein on tlie dales sfaled: OTHER ADDITIONAL FEES � ,r- � _ r ' h6n Retrofit 5.25 Fix►ure .,� � %yH... � � o-c„ Center Pivot Irtio�on Boom Q S40 R0U°"" wTE � i _Vt � 3�+�y�ci�� , �, . ,-, a�e� t ' . ' s t, � ,,»_ ,t ,..�_.<' ......:.� .. ., . . . . . �(J�L.J��J� `� �! c��C%`l` I�f�� - � �., 1 6:3-� 3 6 1 ��'�� ",:` � � � ,� � . : _ . . � ,� rcu mu�"sx�'utY� �i�t�- ` ' �e.�dY , �e ' I [amrie L�CEI�9EDC1)N�CT#t OCOA�A�+fY' ❑OVVN�R .aa�3l�re6��i�dlheelec�riCalwalca�:.� f_ . _ ,. .. . . _ _. . .. ,. . .�a�i � `� .S�- �� _ C'i��. � ,j"=�.``�Ir� - � ,� _ _ �• a::.� � ,. ._� � ry � 4)� � � ` �;�e.�"!d �'if�b { } � � � f . . �- . .�a�-� � �� S r`f s�` 5�� - � e�;� = � 8�� :° ��a � : ,. :i:�ss i�t�s�d`.� . ��►; � t� +�� , � �� ._ _.. �, : � � � �� 5�-a'�� a'�� .._� ��: -- _,.,=_...r - - _ ��