P - 77124� REQUEST FOR ELECTRICAL NSPECTIO s ��`
1�� ��� - 5 81 � Minnesota Board of Electricity �Q(r`����� a;
1821 University Avenue Suite S-128, Saint �aul, Minnesota 55104
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(651)642-0800TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Desaibe -u ' tge �b ck the white copy if necessary - the wo k covered by this request:
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✓ICES / POWER SUPPLIES
0 to 400 Amcere f�D $25
ALARM, COMMUN�CATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Ap aratus $.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit
Center Pivot Irrigation Boom @
Manufadured Home Park Lots i
Recreational Vehicle Park Sites
Su lemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns I Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT �
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80 •,.�„
TOTAL FEE
total fee is $201
that I inspeated the electrical installa6on described herein on the dates slated:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
I IIII II III �1 lil If III II III II III II III II III �� I�
1,8J�25815
ua[e: A/L /�� Rough-in Inspection Required? ❑ Yes �No Inspection Other Than Rough-In: �ady Now ❑ Will Call
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��.,� You must call the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address Y � City�.� \�� A
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Hamson
ador, Company or
3440 Kil
� (ConUador or Owr
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License Number I Master Electrician or Power Limited
License Number
r Lane N. Pl mouth 55441
forming Installation) Please Provide Two (
1jb3,�44-33U0
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