P - 78671REQUEST FOR ELECTRICAL INSPECTION
1��$ �F �F - 2 7 9� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL 0 ADDI ION EPAIR Describe -using the back of the white copy if necessa the work covered by this request:
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6EN RAL F ES Outdoor Li h6n Standard $1 �c.�.c1L
SERVICES / POWER SUPPLIES Traific Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Amcere O 575 Transfortners over 10 KVA �$ 20 .
0 to 200 Am ere ES
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 P� Unit
Each Additional Unit @ $25
Center Pivot Irtivation Boom
IIIII IIIII IIIII IIII! illll 11111IIIII IIIII NI� I�N
14442792
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
GrcuiLs and Two Inspection Trips Each Dwelling Unit �$60
(minimum total fee is $20) � pdJ �-� v
THS �REA FOIt NSPECTIX11bE ONLY
I hereby cerGy that I inspecled the electrical instal�on desc�ibed her�n on tlie da�s stMed:
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nequesc uace: Rough♦n Inspection Required7 U Yes InspeGion Other Than Rough-In: �eady Now � WNI Call
�� '�3 You must call the inspecla wh� readyl Date Ready. . '\
I certiry that I am the� CENSED CONTRACTOR ❑ COIu�ANY ❑ OWNER and hereby request mspection of Uie electrical work at:
Job SRe Address (Street. Box. or Route Pb.) CitY Zip Code
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