P - 79089REQUEST FOR ELECTRICAL INSPECTION
1— 6 y 3� 2 O 7 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
;t,
SERVICES /
0 to 400
401 to 6
Above 8
CIRCUITS / F
0 to 200
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electncity.state.mn.us
❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
�� "� ^ J(it3-if OG�'S� �G2 %D'{�CI� �e�"z
S Outdoor Li htin Standard $1
Traffic Si nal Standard $5
Su lemental Fee $20
Transformers uo to 10 KVA C� S10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparffius $.50
ADDITIONS TO THE GENERAL I
to 12 Units @$50 Per Un
ach Additional Unit @ $25
Center Pivot
IIII II III II �I Ii lll il lll II ill II III II III �� I�
1 6 1 3 2 U 7 8
� Transformer / Power Supply for Siqns / OuOine Liqhtinq $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senice andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
70TAt FEE
(minimum total fee is $20) �0. �D
THIS AREA Fqi IlLSPECip3 USE OKY
I hereby cer6y that I inspecfed the electrical insfalla6on deuribed herein on the dales sfa0ed:
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Request Date: Rough-in Inspection Required? Yes Inspecfion Other Than Rough-In: OReady Na�v � Ca0
��,D —� You must call the inspecta v+h� resdy! Date Ready.
I certiry that I am the �4.ICENSED CONTRACTOR ❑ COt�ANY ❑ OWNER and hereby ►equest inspection of 1he electrica� wak at:
gOqRp OF ELECT2ICITV COPY
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