P - 78411,/� c REQUEST�OR ELECTRICAL INSPECTION
�. ��}� V° 3 91 � Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TlY/M RS 1-800-627-3529 www. electricity.state.mn. us
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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SERVICES I POWER SUPPLIES
0 to 400 Amcere � $25
I CIRCUITS, CIRCUITS OF LESS THAN 50 VOITS
to 12 Units �$50 Per Unit
Center Pivol Irriaation Boom
Su demental Fee $20 � -
Transfortners u to 10 KVA $t0
Transformers over 10 KVA $ 20
Transfortner I Power Su I for S' ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit �$60
Additional Inspec6on Trips @ $20
� Investiaative Fee
(minimum total fee is $20) � p{Q. �
THIS PREA Fdi INSPECiOR USE ONLv
I hereby certiry that I inspec0ed fhe elec6ical insfalla6on described haein on the dales st�ed:
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Raph�n Yyp�y�n II�i�M? Y�a Ir�spection Other Than Rough-In: ❑Ready Now Will Call
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NSEO CONTRA�TdR �ANY C� �YVNtR and hereby request inspection of the electrical work at::
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