P - 78016REQUEST FOR ELECTRICAL INSPECTION
1����- 7 31 7❑ Minnesota Board of Electricity
G� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' I �j (651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
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� W 0 REMODEL ❑ ADDITIQN O REPAIR Describe -using the back of tf� white copy if necessary - the xrork covered by this request:
SUPPLIES
Fee
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns I Outline Li htin $5
0 to 200 Am e b5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes ihe Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri $20
Each Svstem Device or Apparatus @$.50 Inves6 ative Fee
_Y DWELLINGS PER UNI TOTAL FEE
Units @ S5o Per unit (minimum total fee is $20)
dditional Unit @$25 T�is �aEn Fat irarECron use aar
I hereby cer6fy that I inspected the elettrical installa6on described herein on the dates sUted:
OTHER ADDITIONAL FEES �q(,�,,,F C'f -�� t i, r� C
Retrofit $.25 r Fixture ��� J
Pivot Irriaation Boom � S40 A A A � R01GH1N w,TE
Sites
Hour
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15637317
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rceques[ uate: Rough-in Inspection Required? LJ Yes �'No Inspedion Other Than Rough-In: LJReady Now� Wfll Call
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You must call the inspector when readyl Date Ready:
I certify that I am the �CENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request inspection of ihe elecUical work at::