P - 78754REQUEST FOR ELECTRICAL INSPECTION
1� 4 9 7- 2 01 � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
G� 'a'�.G ��2-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
� �
❑ NEW ❑ REMODEL ❑ ADDITION _ ribe -using the back of Ne white copy if necessary - the xrork covered by this request:
�
FEES
SERVICES I POWER SUPPLIES
0 to 400 Amcere CaD $25
IMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
THE GENERAL FEES
3 to 12 Units �$50 Per Unft
Each Additional Unit � $25
OTHER ADDITI01
Ligh6ng Retrofit � $.25 per Fixture
Center Pivot Irtiaation Boom � S4(
Fbur
Mile
I lui ii III il III II III II III II III II III II III � I� I�il
L 4 9 7 2 0 1 2
Outdoor
ONE & TWO FAMILY OWELLINGS, EACH UNIT
Includes fhe Service andlor Power Supply up to 500 Amperes, All
Gr�uits and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips � $20
Investiaa6ve Fee
ivin�rte
(minimum total fee is $20) �% ' �
T HIS ARFA FIXt IIEPECTIXi USE QlY
I hereby cer6fy Mat I inspecled the elec6ical i�pllatlon described hererc� an tl�e daBes staled:
30390
,e �<!/ 7
R� �: �-SO
Rough-in InspeGion Required? ❑ Yes No Inspection pther Than Rough-In: y Now O WRI Cell
� You must call the inspecta when ready! pate Re�Y
I certiry that I am the � ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and heieby request inspection of ihe electrica� wo�C at;
iNSTnuc-ans oN
............r �.t.. � tiu i r wrr
EB-000�1M74 8.7.2002