P - 75890REQUEST FOR ELECTRICAL INSPECTION �°'
1� 9 9 7°� 0�� Minnesota Board of Electricity
1821 Universiiy Avenue Suite S-1 ZS, Saint Paul, Minnesota 55104
(659)642-0800TTY/MRS 1-800-627-3529 w�vw.edectricity.state.mn.us f'' ���
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DeSCribeysieg;?he�back of the white copy ff - the work covered is request:
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GENERAL F Outdoor Lighting dard @$1
0 to 400
:URS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDffIONS TO THE GENERAL I
FEES
CeMer Pivot Irtigatlon B�m @
Manufactured Home Park Lots (
Recreatlonal Vehicle Park Sites
INSTALLATION MAY BE ORDEREI
I�II�I�IIIIIuIUIIu�Ulllll�ll��l��l�
19979087
TransFormers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si s/ Oudine Li Min $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two InspecUon Tdps Each DwelPmg Unit @$80
Additional Ins 'on Tri $20
Investigative F�
Reins 'on Fee $20
TOTAL FEE `7 O S1
(minimum total f� is $20) �--
Tt119 ARER FOR PI�ELTOR IuE O�u.Y
I hereby cettify that I inspe�ed the elediicel hahallaUon des�ed herein on fhe dates stated:
IF NOT
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��l Rough-Inlnspecdon Requlred? ❑Yes Q� Inspection Other Than Rough-In: L�iReady Now�IPill Cap
� ��� v You must call the Ins�r when readyl Date Ready.
I certify that I am the ENSED CONTRACTOR ❑ COMPAIVY ❑ OWNER and hereby request inspection of the electrical work at
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Township Sedion Range Fire No. CouMy
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