P - 78901REQUEST FOR ELECTRICAL INSPECTION
- 6 6 0- 719 ❑4 Minnesota Board of Elertriciry -
1821 University Av ui ' S-128, SaiM Paul, Minnesota 55104
(651)642-08Q0 -800-627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ON 0 REPAIR Describ� -using t�bacJt of the white co if necessary - the work covered by this request:
D����.� ii /� �A � /iAwil A�/ .
FEES
SERVICES /
— 0�
1
10 KVA � $70
OKVA�S20
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 2(10 Am re $10 Includes ihe Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspec6on Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Inspection Trips @$20 _
Center Pivot
3S (PER UNI� TOTAL FEE ��/� �,,,/�
Per Unit -r (minimum total fee is $20) pL(/ U��
��,LS TH6 NiFA FOR IlSPECTdi USE QLV
—� I hereby cer6fy Mffi I inspecOeO Me electrical i�fallation described herein on the da0es staBe4:
Hour
Mile
4Y BE
IIIII IIIII lllll IIIII II(II IIIII IIIII IIIII �� !�
� �-�2 : _ ��
16607194 i�
�
�4oy- ol�s�
ReQuest Date: Roughin Inspection Required? � Yes ❑ No Ins
Pedion Other Than Raugh-In: y Now � Vlfill Call
• Vou must call the inspecla wh� ready! Da(e Ready
I certify that I am the ��ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
e�ec i �cm coPr
EB-00001A-7t 8.1.20D2