P - 77739REQUEST FOR ELECTRICAL INSPECTION �
1— 6 3 7-19 0� Minnesota Board of ElecViaty :
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
" '`' � (651) 642-0800 TTY RS 00�27-3529 www.e[ectriciry.state.mn.us
� NEW ❑ REMODEL ❑ ADDITION O REPAIR Describe -y� the back of the white copy ff necessary - the work covered by this request:
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SERVICES I
Outdoor Ligh6ng Stand�d
Traific Sanal Shandard � ;
u to Nu nm re ib ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlw Power Supply up to 500 Amperes, Ail
2M, COMMUNICP,TION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit � E80
;UITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri $20
Each S stem Device or atus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins tion Fce 520
fIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units @ S50 Per Unit (minimum total fee is $20) Q�,�
E2Ch Addi6onal Unit �$25 rHana�nF«+x�croa us� «a.
I hereby cer6fy that I inspec6ed the electrical instaBa6on described haein on the dates staled:
OTHER ADDITIONAL FEES � �D� v ��O
htin Retrofit E.25 Fixture
Center Pivot Irri�ation Boom � S40 R0�"'" �TE
2—ZZ `oS �
IIII �(I) II III II III II I�I II III I) (I� II I�I �� I�
16371908
�Q�� �e� Rough-in Inspection Required? ❑ Yes ❑ No Inspeaion Other Than Rough-In: eady Now C�Vill Call
You must call tAe inspector when ready! pe� �y. //�r `h-'-1
I certi(y lhat I am 1he ❑ UCENSED CONTRACTOR ❑CON�ANY ❑ OWNER and hereb `''/ !
Y reQue.st inspection of ihe electrical work at:
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