P - 77001REQUEST FOR ELECTRICAL INSPECTION
r? � �����/� Minnesota Board of Electricity
G 't 1821 University Avenue Suite S-128. Sairrt Paul, Minnesota 55104
(651J642-08001TYlMRS 1-800-627-3529 www.elecbicity.state.mn.us
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GENERAL FEES Outdaor Liahtina Sta�ard id 51
I SERVICES /
� CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Traffic Sianal Standard
i raiurortners over iu KvA 5 zu •
Transfomier / Power Supply for Sgns / Outline L'qhting � S5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
CircuiGs and Two Inspection Trips Fach Dwelling Unit @$80
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2 Units @$50 Per unit (minimum total fee is $20) ��
Additional Unit @$25 nes u�nFOrs ir�croa u� orxr
L KCVOnt �."Lb pCf Fb(tUf2 I hereby cerdfy that I inapected tlie eNdrical instaAafion despil�ed herein on y�e daks sG
Center Pivot I' Gon Boom S40 f01�"'" r � w�
Manutactured Fbme Park Lots 325 �'kw--"'�RY � 6-%Z-�`'"�
Recreational Vehide Park Sites $5 '"�"�'�" aT�
Bond In S20 ^ l�� c
Special inspection �1 S30 per Hour °�'"�""�'� a
, � THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WiTHIN 12 MONTHS
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�: RougM�n I�specdon Required? Yes ❑ No I
napecdon OU�er Than RougM�: ❑ R�dy Now �tl CaM
���5/� You must call the inspector when ready! Date Ready:
I c�rtify that I am the � UCENSED CQNTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wak at
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l�pratura (Contractor or Oxmer Performinp InstaNatlon) Please provide Two (2) Phone Numbers
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