P - 76311. REQIJ�ST FOR ELECTRICAL INSPECTION '
2�w� °--=k �� 4 21 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55904
, (651) 642-0800 TTY/MRS 1-800-62 .electricity.state.mn.us
Descnbe-usi�9V I�c�/lX �l I�W/ �' /Ul(�C���4`� T 1 /. l� �C Ll�! �'
0 to 400
0
Above 200 Am re$10 � " Includes the Service andlor Power Suppty up to 500 Amperes, All
tM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ir�spection Trips Each Dwelling Unit (d� $80
,URS, CIRGUITS OF LESS TFIAN 50 VOLTS Addidonal I ' n Td $20
Each S m Device w A @$.50 Im�6gative Fee
ADDITIONS TO THE GEWERAL FEES Rems 'on Fee $20
fIFAMILY DWELLINGS PER UN TOTAL FEE
3 to 72 Uni� @$50 Per Unft (minimum total fee is $20)
Each Addidonal Unft @ $25 '�s"�"�+"+s"Em°R'�°�n''
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OTHER ADDRIONAL FEES
Li htl Retrofit @$25 per Focdue I hereby certlfy Umt I 6rspeded tlre et�l 6�tauauon d�d herem on the dates s�ed:
CeMer Pivot Irtigation Boom (�a. $40 R01�" �' 0A7E
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I ��SQ ,� � FOR Of�tCE USE ONLY
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Rough-in Inspe�tlon Requfred7 ❑Yes� Inspecdon OtherThan Raugh-In: Idow �Wip Cap
You must call the inspector when readyl Date Ready. � (�
I c;ertiFy that I am the�LICENSED CONTRACTOR ❑ CQMPANY � OWNER artd hereby request inspection of the electrical work at
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Licenae Number
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