P - 777241 '7 , �/ REQUEST FOR ELECTRICAL INSPECTION
1� 1 0�- 0 3 9�� Minnesota Board of ElecVicity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ADDITION 0 REPAIR Describe -using the back of the whRe copy rf necessary - the work covered by ihis request:
It 9 �lr�_ Lit�(2� t�iVtC�O�L���
� SERVICES / POWER SUPPLIES
0 to 400 Amcere � S25
I CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Lighting Rehofit @ $.25 per Fixture
Center Pivot Irrigation Boom @ $4(
Manufactured Home Park Lots p$
Recreational Vehicle Park Sites �l
IIIII II III III�� II III II III I) III �IIII I�III �� I�
L7070392
Transformers u to 10 KVA $10
Transformers over 10 KVA �$ 20
Transfortner I Power Supply fa Siqns I OuUine Liqhtinq .$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
Investi ative Fee
Reins tion Fee $20
TOTAL FEE h�7
(minimum total fee is $20) J� •��
iH15 ARFA FOR INSPECiOR USE prlY
I hereby cer0ry that I inspected the electrical insfallalion described herein on the dates stated:
Zo�S- �ras.�
--._��
IF NOT COMPLETED WITHIN 12 MONTHS �
Request Date: Rough-in Inspection Required? ❑ Yes L�J No Inspection Other Than Rough-In: ❑Ready Now $ Will Call
I"' — You must call the inspector when ready! Date Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::