P - 79216REQUEST FOR ELECTRICAL INSPECTION
� � � 6 S � [ � � � Minnesota Board of Electricity -
J 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
GENERALFEES
I POWER SUPPLIES
ENERGY cSAVEI?'SbSWITCH te copy if necessary - the work covered by this request:
Outdoor Liahtinq Siandard (a) $1
� Above 200 Ampere @$10 _ I__
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Pivot Irriqa6on Boom
1 ���I�I��
II� � III II I!I II I� I I I II II �I II IH a III
1? 6 S S 3 8 9
0 KVA
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
(minimum total fee is $20) I 20,50
rMS MEn:aa RasaECiat usE aar
I hereby cer0y that I inspec0ed the ek�ctrical insfalla6on described herein on ttie dates sta6ed:
�
���.�
��� � � ����� sQ
Kequest oate: Rough-in InspecGon Required'? tJ Ves LJ No Inspection Other Than Rough-In: LJReady Now LJ Will Call
0?�d� You must call the insD�a �� ready! Date Ready:
I certify that I am the ❑%�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he�eby request inspection of the electrical work at:
INSTRUCTONB ON BACK OF VELLOW COPY BOARD OF ELECTRICITV CAPV E&00001M14 8.1. 2002