P - 76980REQUEST FOR ELECTRICAL INSPECTION
� 2��-� CJ � 7 5 7 � Minnesota Board of Electricity -
=�. 1821 University Avenue Suite 5-128, Saint Paui, Minnesota 55104
• (65,1)642-OSOOTTY/MRS1-800-627-3529www.electricity.state.mn.us
Desai us' ttie back of the white cbpy'rf ry- ihe work covered by this request:
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Standard
�irc�vi i� rttut Transformer! Power Su I for S' ru /0utline ' hti S5
j ' 0 to 2 re$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
iAbove 200 Am $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING CircuRs and Two Inspectan Trips Each DweNing UnA @$80 I
j CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addfional I ' Tri $20
' Each S em Device w ratus $.50 InvesC ative Fee
� ADDITIONS TO THE GENERAL FEES Reins ' Fee $20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE �
3 to 12 Units � a50 Per Unit (minimum total fee is $20) ,Q� �
EachAdditionalUnfl(a�325 ��, nusa�nrokrcsvecrorsuseauv
OTHER ADDITIONAL FEES �
Li hti RBtroflt $.25 f FixtUre I hereby ce�tify that I inspeded tlre electrical ir�llabon desaibed herein on the dates stated:
iCenter Pivot I' 'on Boom $40 "�"" w�
i Manufactured Home Park Lots $25 �-^ Z� g%
Recreational Vehide Park Sites $5 F"+°L �""^ ` �� A��
Se rate Bondi Ins ' n $20
S I Ins $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED {F NOT COMPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? Yes ❑No I
nspeciion OMer Than RuugMln: � Ready Now � Will Call
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-T 0 You must call the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address Cjh,
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T���P Secdon Range Fire No. County
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Contractor License Number Master Elechiaan or Power Limited Te
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anDanv or Owner Perfortnma InstallaLonl
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Please ro�rid wv (2) Phone Numbers Indudi
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