P - 75452REQUEST FOR ELECTRICAL IIVSPECTION °' p
1��o � 2 6� � Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
° (651) 642-0800 TTY/MRS 1-800-627-3529 www.elech^icity.state.mn.us
riba -using the back of the white copy'rf necessary - the work covered by this request: �
C�7�'-!N ���P�� Oi`� uQ� fL� �� 1�'� f�?/�2 �.
GENERAL FEES Outdoor Liphtinq Standard na. $1
0 to 400
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device ar Apparatus @ $.50
ADDRIONS TO THE GENERAL I
Center Pivot Irtigation Boom �
Manufactured Home Park Lots
S e.cial Ir�specUon �$30 er Hour
S'al Ins on @$.31 r M�e
THIS INSTALLATION MAY BE ORDERED D
I �III � ��! 0 �i� �I hi � �II II �I II I�� a I� 0� ��
18202689
Transfomrers over 10 KVA $ Zfl
Transformer / Poxrer Su I for Si ns / OuUine Li Yfin $5
ONE & TWO FAMILY DINEWNGS, EACH UNIT
Inctudes ihe Service and/or Power Supply up to 500 Am�res, AII
Circufts and Two I�pectlon Tdps Each Dwellirtg Unit @$80
Additional Ins 'on Tri $20
Imestlgative Fee
Reins on F� $20
TOTALPEE
(minimum total fee is $20) I� 5—
NOV ,��� ��Y
�C� d 2008 r�v�,
I hereby cerdfy that I inspeded ti� elec�Ical mstalledon des�d i'reretri on s�ted:
aattm w on�
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F'JkOrF'i'EUS� LY
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Rough-in InspecUon R�uired? �Y� ❑ No Inspectlon Othar Than Rough-In: ❑ Ready Now�YVN Call
' �� You must call the inspedor when readyl Date Ready.
7
fhat I am the ❑ UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Street Addreas City
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� Section Range Fire No. CouMy
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iador, Company or
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Please Provide Two (2) Phorre Number
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�se Number Master Eledrician or
License Number
Please Provide Two (2) Phone Number
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