P - 79133REQUEST FOR ELECTRICAL INSPECTION
1'� ��t.7 - 4 5 6� ��nnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' (651)642-0800TTY/MRS 1-800-627-3529 www•electriciry.state.mn.us
� NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
�ES/
to 400
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Standard
Transformers over 10 KVA $ 20
Transformer I Power Supply for Signs I Outline Ligh6ng @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Paxer Supply up to 500 Amperes, All
CircuiLs and Two Inspection Trips Each Dwelling Unit �$80
ADDITIONS TO THE GENERAL FEES Reins tion Fee a� bzu
fIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to t2 Units @$50 Per Un+t (minimum total fee is $20) �.�
E2Ch Addi60n21 Unit Q$25 ���s � F� ���cTa+�E �r
I hereby certify that I inspecled the elechical installation described herein on tl�e dates sta�d:
OTHERADDITIONAL FEES � C�v �L � 6�,3 l�--
Li htin Retrofit $.25 er Fi�Rure
ROIIGHIN DATE
Center Pivot Irriga6on Boom � $40
IIII ll �I II III Il.l(I Il �l! II III II III II IIl Il lll l�ll
1 7 2 5 4 5 6 6
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Keques� uace: Rough-in Inspection Required? � Yes ❑ No Inspeqion Other Than Raigh-in: �Ready Now �VMII Cell
12-8-04 You must call the inspector when ready! Date Ready.
I certiiy that I am the C�LICENSED CONTRACTOR ❑COIuIPANY ❑ OWNER arid hereby request inspection of the electrical work at: