P - 79295REQUEST FOR ELECTRICAL INSPECTION
��� t� J_ 5 4 8 0 Minnesota Board of Electricity �
1$21 University Avenue Suite S-128, Saint Paui, Minnesota 55104
(651) 642-080Q TTY(MRS 1-8�0-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -usin the back of the white copy if necessary - the work covered by this request:
7�CEL Er1ER�Y SA1/�f�'S St�l;T�H
GENERAL FEES Outdoor Li htin Standard $t
SERVICES ! POWER SUPPLIES Traffic Sianal Standard �$5
0 to 400 Ar
401 to 80D
0 to 200 Am re S5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes the Senice andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$BO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s$20
Each Svstem Device or Aooaratus (d 5.50 Investiqative Fee
_..- — ---... _- — — -
3 to 12 Units @$50 Per Unit (minimum tota{ fee is $20) �0 ���
E2Ch Additi0n21 Unit @$25 rws naEn �an niscECroa usE aar
I herebY ��Y �� I inspected the elecCical installa6on described hefein On tlie dates sUled:
OTHER ADDITIONAL FEES
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Center Pivot Irrioation Boom
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Request Date: Rough-in Inspection Required? ❑ Yes Inspection Ott�er Than RougMn: O dy Nrnv � Will Call
Q�af dQ You must call the inspecta when ready! Oate Ready.
I certify that I am She C}r�ICENSED CONIRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICfTY COPY E600001M1t 8.1. 20�2