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P - 76396REQUEST FOR ELECTRICAL INSPECTION 1 s� 8�, �w �� 5 � Minnesota Board of Electricity 1821 Uni ersity Avenue Suite S-128, Saint Paui, Minnesota 55104 (6 - 00 TTY/MRS 1-800-627-3529 wxryv.electricity.state.mn.us �4 Describe -using the back of the white copy if necessary e red by this request: FEES I SERVICES I POWER Above 200 Am ere $10 ALARM, COMMUNICATION, REMOTE CANTROL CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device or Apparatus $.50 ADDITIONS TO THE GENERAL 3 to 12 Units @$50 Pe Each Additional Unit @ � Retrofit @ $.25 per Fi� Pivot Irrigation Boom � ctured Home Park Lots ��� Outdoor Lightin Standard $1 Traffic Si nal Standard @ $5 Supplemental Fee $20 Transformers u to 10 KVA $10 Transformers over t0 KVA $ 20 Transformer / Power Su I for Si ns 1 Oudine Li htin $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service andlor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit @$80 Additional Inspection Trips @ $20 Investigative Fee TOTALFEE /�� total fee is $20) r}�(.> ` I insoeded the electrical installation described herein on lhe dates stated: ��/�''�`"..—..�� S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WlTHIN 12 - ��'`? � I IIII II III II lii II III IIlII II Ili II lil II III �� I�I2 C���J ��'1�,/, L 9 8 4 1 1 5 4 =J "�l> "� / ,��7" <J" TG� Date: Rough-in Inspection Required? ❑Yes �Jo Inspection Other Than Rough-in: �Ready Now �Will Call �� a�� You must call the inspector when ready! Date Ready: �$�� I certify that I am the'�.LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: