P - 79206REQUEST FOR ELECTRICAL INSPECTION -= �
��` � C? �- 5 2 6� Minnesota Board of Electricity - :
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T1Y/MRS 1-500-627-3529 www.electricirystate.mn.us
NEW ❑ REMODEL ❑ ADDITIQeEL
X
SERVICES 1 I
0 to 400
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS TNAN 50 VOLTS
Each System Device or Apparatus @ 8.50
ADDITIONS TO THE GENERAL
� Descnbg u�g,thgb�ck of„�hg,white copy if necessary - the work covered by this request:
Outdoor
ONE & TWO FAMILY DWELLINGS, EACH UNI7
Includes the Senice andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
s to 12 Units @$50 Per Unit (minimum total fee is $20) I 2Q•�0
Each Additional Unit @$z5 rNis nnEn coa iraaECTOa usE orar
I herCby cer6y that I inspecMd Me electrical installa6on described Aerein on tlie dates staled:
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 r Fixture
Center Pivot Irti ation Boom $40 R01�"'" °A E
Manufxtured Home Park Lots $25
Recreational Vehicle Park Sites $5 F�wa ws�cr�a, / !/w e
Se arate Bondin Ins tion $20 `� �`" �� �
S ial Ins tion $30 r Hour �0' °"TE
S ial lns tion $.31 r Mile
S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTiiS
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Request Dffie: Rough-in Inspection Required7 ❑ Yes ❑`Wo Inspedion Other Tha� Rough-In: ❑Ready Now G Will Call
Q7�� You must call the inspedor when ready! Date Ready:
I certify fhat I am the �iCENSED CONTRACTOR ❑CORAPANY ❑ OWNFR and hereby request inspection of tl�e electrical work at:
INSTRUCTONS ON BACK OF YELLOW COPY BOAR� OF ELECTRICITV COPY EB-OOOOlA-14 8.1. 2002