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P - 784081-49�-2�3 � .�'-�y�� ❑ NEW REMOD�L O ADDITION Z��,sar� // GENERALfEES SERVICES / POWER SUPPLIES REQUEST FOR ELECTRICAL INSPECTION Minnesota Board of Electricity 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us 2 Describe -ysing the back of the white copy if necessary - t��d by thi�quest: s I, COMMUNICATION, REMOTE CONTROL, SIGNALING ITS, CIRCUITS OF LESS THAN 50 VOLTS �ch System Device or Apparatus @ $.50 ADDITIONS TO THE GENERAL FEES =AMILY DWELLINGS PER UNI to 12 Units �$50 Per Unit ach Additional Unit a�. $25 Retrofit $. Pivot Irriga6oi ictured Home tion� Vehicle IIII�IIIIIIIIIIIIIIIIIII�I�III��I��I� Traffic Si nal Standard $5 Su lemental Fee $20 Transformers u to 10 KVA $10 Transformers over 10 KVA $ 20 Transformer I Power Su I for Si ns / OuNine Li htin $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit @$80 Additianal Ins tion Tri $20 Inves6 ative Fee Reins ction Fee $20 TOTALFEE .— (minimum total fee is $20) � � TNISMEAFORINSPECTpYUSEIXdV - I hereby cerMy that 1 inspected the electrical insGtla6on desciibed herein an the Oates stated: �J � 1497283Q �� Req D e: Rough-in Inspection Required? Yes No Inspection Other Than RougMn: �Ready Now ❑ WiN Cell 1 � You must call the inspector when ready! Date Ready: � — I certify that 1 am ihe LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at: � Job Site Address Street, Box, or e No.) City Zip Cod�-��2 �' �L`O� � t� e�s 7J� � ction Township, Range .� CouMy ��(� �� /1/i>%�'l.c� 0 ��G��.�.✓l�" �/� �% eweK oF reu.ow eorr eoaxo oF e�etrvem coPr � ) � ) 9 � „�- � . aecindan or Number � "�GC� I E&OOOOtA-14 8.1.20D2