P - 78229REQUEST FOR ELECTRICAL INSPECTION
1� 4 0 7° 5 6 4� Minnesota Board of ElecVicity
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
` (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ REMODEL ADDITION 0 REPAIR Describe -using the back of the white copy 'rf necessary - the work covered by this request:
Add d� hot�s � F/,� s,c�►,,
GENERAL FEES Outdoor ' htin Standard S1
t! POWER SUPPLIES TraRc Si n� Standard $5
00 Am re $25 Su lemental Fee $20
� 800 Am re S50 Transformers u to 10 KVA $10
: 800 Am re=75 Transfortners over 10 KVA S 20
I FEEDERS Transfortner I Power Su I for Si ns I Outline Li hGn $5
00 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
; 200 Am re $10 Includes ihe Service andlor Power Supply up to 500 Amperes, All
OMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ., tion Tri $20
S��stem Device or Apparatus �$.50 /_ pd Inves69ative fee
fIFAMILY DWELLINGS I
3 to 12 Units � E50 Per 1
Each Additional Unit Lal $:
OTHER
LighGng Retrofit @ $.25 p
Center Pivot Irriaation Bo�
Mile
I lill ll lll ll lli li lll ll lll ll lll ll lil ll l� �� l�
14075642
TOTAL FEE I �
(minimum total fee is $20) �S
THIS MEA FOR INSPECipi 116E OI1V
I hereby cerEy that I inspected the electrical installation described herein on ttie dates stated:
0
DISCONNECTED IF NOT COMPL
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^w"F'� 1°�O• Rough�n Inspection Required? ❑ Yes �( No �nspec,y�pn ptht,y Than Rough-In: ❑Ready Now Will Call
����/� You must call the inspector when ready! Date Ready:
I certify that I am tt�e �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
_ _ _ _ _. _ .....,�.....� ��c.. � n�..� � � �.vr. E8-OOOOtA-14 8.1. 2002