P - 771311-497-450
FEES
I SERVICES /
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Unifs �$50 Per Unit
Each Additional Unft � E25
OTHER ADDITIO
Lighting Retrofil @ E.25 per Fixture
Center Pivot Irtigation Boom � yK
Manufactured Home Park Lots @ S
Reaeational Vehicle Park Sites @
SeDarate Bonding Inspection @ $2
Soecial InsoecUon @ S30 oer Hour
I lul II Iil II III II ill II III II III II III II III �� f'�I
14974505
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �v�,'� —� ��%� /
1821 University Avenue Suite S-128, Saint Paul, Minnesot�55104
(651) 642-0800 T'fY/MRS 1-800�27-3529 www.electricity.state.mn.us
2 '-using the back of the white copy if necessary - the work covered by this request:
-�2
OuMoor Li htin Standard $1
Tra(fic Siunal Standard � SS
Include.s fhe Service and/or Power Suppiy up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) ,
T1M5 MEA FOR NbPECTOR USE q1Y
I hereby certify Mat I inspeckd the electrical instaNation deuribed herein on the daBes stffied:
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KeqW�t ua[e�_ � Rough-in Inspection Required? LJ Yes p(NO Irupedion Other Than Rough-In: Ipfi�ady Now L] Wfll Call
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(� You must call the inspector when readyl Date Ready:
i certi(y that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby req�st inspec.�Uon of the electricxl work at::
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EB-0OOOtM11 8.1. 2002