P - 78150� REQUEST FOR ELECTRICAL INSPECTION
�� 5 O �- 4 6 9� Minnesota Board of Electriaty
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800�27-3529 www.electricity.state.mn.us
D REPAIR De�cribe ing the bacl� d the whte copy 'rfjnecessary - the work wvered by ihis request:
)MMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
TO THE GENERAL
3 to 12 Units @$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
LighGng Rehofit @ $.25 per Fixture
Center Pivot Irriaation Boom � S40 s!
IIII II III II III II III II �I� II I�� �I !�� �� h� N I� ��I
15804693
Outdoor Lighting Standard
Trafic Sianal Standard �'
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service �dlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @ S80
TOTAL FEE I
(minimum total fee is $20) � .
TM4S MEA Fdi HbPECiOR tISE MY
I hereby cerdry that I inspected the electrical inslalW6on desuibed herein on tl�e dates sfa0ed:
115GONNEGTED IF NOT COMPLETED WITHIN 12 MO�
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Req Date: Rough�n Inspection Required? ❑ Yes ❑ No InspeUion Other Than Rough-In: Ready Now ❑ Wdl Call
'' You must call the inspector when ready! Date Ready:
I oertify that I am the �ICENSED CONTRACTOR OCOA�PANY ❑ OWNER and he�eby request inspecfion of the elecirical work at:
INSTRUCTONS ON BACK OF YELLOW COW