P - 79149� REQUEST FOR ELEC7RICAL INSPECTION � �
1�i� Q�`� o/� ,� `1 � Min�esota Board of Electricity -
�� V �f `f' u �gp� University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ NEW ❑ REM�DEI ❑ ADDITION REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
FEES
to
AIARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus Ca? $.50
Unit
Center Pivot
I IIII II R�� 11 lil � Ill !i i'! 11 lii II III II lif ��I I
1 7 2 8 9 0 4 2
Outdoor
Transfortners
� Transformer / Power Supply for Signs / OuUme LiqhUng (� 55
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Txro Inspection Trips Each Dwelling Unit @$80
�v�ru.rcc
(minimum total fee is $20j � ��d
THIS AREA FOit INSPECiOft USE ONLY
1 hereby cerGty Ihat 1 inspecte0 Ihe elechrical installation described herein on tlie dales sWOSd:
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`R�'�� ��� Rcwgh-in Inspection Required? ❑ Yes �+No Inspection Other Than Ragh-In: ❑Ready Now ❑ VWII Call
IJ Z.. '' �— O tF You must call fhe inspeda when ready! Date Ready.
I certify fhat I am the ❑ LICENSED CONTRACTOR ❑COMIPANY �pWNER and hereby request inspection of ri�e electricai work at: