P - 75886REQUEST FOR ELECTRICAL INSPECTION ��"
1— 9��� 5� 4� Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
Describe -using th�z back of the arhite copy'rf n�ry - the work covered �y U�is reAuest:
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GENERAL FEES Outdoor Liahtina Standard (a� $1
Transformers u to 10 KVA $10
Trarisfortners over 90 KVA @$ 20
Transformer / Power Supply for Signs / OuNine Lighting @$5
ONE & TVI�O FAMILY DWEWNGS, ERCH UNIT
Includes the Service and/or Power Supply up to 500 Amper�, All
Circuits and Two Inspectlon Trips Each Dwe�ing Unft @$80
CIRCUITS OF LESS THAN 50 VOLTS
iystem Davice or APparatus @ $.50
ADDITIONS TO THE GENERAL FEES
CeMer Pivot Irriaation Boom
Fee a $20
TOTAL PEE �> �o
iimum total fee is $20) y B m
I ms{�cted tlre eleddral histallallon desc�ibed herafn on the dat� ateted:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 42 MONTHS
FGR UrFiCe USE O`::L'*'
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��� Rough-in InspecUon Required? �Yes ❑ No Inspectlon Other Than Rough-In: f,�Ready Now ❑WW(III Call
��, �1 �(F+ You must call the (nspedor when readyl Date Ready. ''
I cerpfy that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby requesf inspection of the electrical work at
Job Site Street Address City
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