P - 76062REQUEST FOR ELECTRICAL INSPECTION
1����� o� v � Minnesota Board of Electricity
1821 University Avenue Suice 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Describe -using�ha back of the whRe copy if ne�esS�.the yrerk,cqu�ed.by�i� �e,pu,� , J � T I L'{-�
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GENERAL FEES Outdoor Liahfina Standard (�D $1
Transfortners up to 1(
Transformers over 10
2b0 re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
�AMUNICATION, REMOTE CONTROL, SIGNALING C(rcuits and Two Inspectlon Trips Each Dwelling Unft @$80
CIRCUITS OF LESS THAN 50 VOLTS Addi�onal Ins 'on Tri $20
i tem Device or Apparatus @$.50 Investigative Fee
ADDITIONS TO THE GENERAL FEES Reins ction Fee @$20
ILY DWELLINGS PER UNI TOTAL FEE �, 5(j
! Units @$50 Per Unit (minimum total fee is $20)
ldditi01181 Unit @$25 nius u�a von wsa�croa ug onar
OTHER ADDITIONAL FEES
g R@tr6flt �$.25 pef FiXture I hereby certify that I inspected the etectrical installatinn described herein on the dat� sla�:
Pivot krigation Boom (�a. $40 R01�' �' �T�
IMS INSTALLATION MAY BE ORDERE�
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JNECTED IF NOT COMPLETED WITHIN 12 MONTh
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�' Rough-in Inspection Required7 ❑ Ye $] No Inspecbon Other Than Rough-In: �Ready Now ❑ Will Call
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You must call the inspector when ready! Date Ready:
1�rtily that I am the L] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work afi
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:ontractor License Number Master Electrician ar
CP� Q(�s$J License Number
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