P - 79150REQUEST FOR ELECTRICAL INSPECTION
1� 7 2 9- 512 � Minnesota Board of Electricity -
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� `�"3"� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NE REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Liah6na Standard (� $1
SERVICES I POWER SUPPLIES
0 to 400 Amcere (�a $25
200
ALARM, COMMUNICATlON, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 5D VOLTS
Each Svstem Device or Ao�aratus � 5.50
Center Pivot Irrigation Boom
Manu(actured Home Paric Lc
�.31 per Mile
)N MAY BE
IIII II �� II li� II III I� ��l II III II III II I!I �� I�
1 7 2 9 5 1 2 2
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit @$80
TOTAL FEE I /� ,�U
(minimum total fee is $20) QC� °'�
,µs ��,F�a��,���.,
I hereby certify that I inspected the electrical installa6on described herein on the dates staled:
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^°`+�°�� �n�C. Rough-in Inspection Required? Q Yes No
,Z^� 6� / Mspedion OM�er Than Rough-In: �Ready Now YVill Call
`� You must call the inspector when ready! pate Ready
I certify that I am the �LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspechion of the eiec6ical work at:
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