P - 76091REQUEST FOR ELECTRICAL INSPECTION � �'
�- 9 3 3���� � Minnesota Board of Electricity ,
1821 University Avenue Suite S-128, Saint Paul, Minnasota 551 U4
� � (651) 642-0800 TTY/MRS 1-800-627-3529 www.electrrcaty.state.mn.us
Describ�ys'�ig tha badc of yte wh4e coPY'rf ne�,essaty - the work cpvered by flds request: 1�I �P �
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Fee (a� $20
up to 10 KVA @ $70
over 10 KVA C� $ 20
2tl0 Am re $10 Includes the Service andlor Power Suppty up to 500 Amperes, M
IMMUNICATION, REMOTE COMROL, SIGNALING Circuits and Two Insp�on Trips Each Dxrelling Unft @$80
CIRCUITS OF LESS TFIAN 50 VOLTS Additlonal Ins 'on Tri $20
i Device or aratus @$.50 Investlgative Fee
ADDITIONS TO THE GENERAL FEES Reinsaectlon F� C�D $ZO
Center Pivot Irtiaatlon Boom
TOTALFEE
total fee is $20� �� • ��
I herabvi ceNN thet I Insueded the elechical i�Vattnn desaibed hereln on fhe det� atated:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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uare:n� y Raugh-in Inspection Required? ❑ Yes Q1Qo Inapectlon Other Than Rough-In: ❑ Ready Now �'461tl Call
i�� �� vb u must caU the inspedor when readyl Date Ready.
I certify that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request ins�tion of the electrical work at
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ng Address (Conhador, Com or Owner Performfig Installatlon
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i S nature (Contractor or er P ing tion) Please Provide Two (2) Phorre Numbers I
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