P - 75255REQUEST FOR ELECTRICAL INSPECTION �'
2� 0��� 1� 6� �innesota Board of Electricity
�r- 1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
� (651) 642-OSOO 1lY/MRS 1-800-627-3529 www.e[ectricity.state.mn.ees
D be -using the bac�c of the white copy ff necessary - tFre work covered by this�a u�t:
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Traffic Sianal Standard
10 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNR
200 Am $10 Includes the Service andlor Pawer Suppiy up to 500
)MMUNICATION, REMOTE CANTROL, SIGNALING Circuits and Two Inspection Trips Each
CIRCUITS OF LESS THAN 50 VOLTS Addfional I 'on Tri $20
iystem Device or Aaaaratus an. $.50 Investiaativ Fe,e
total fee is
$80
U RetrOfit $25 r Fodwe I herebfr ed tlre eiectrical InstaOatlon d� Irerein on �e detes s�ted:
Center Pivot Irri 'on 800m (d� $40 �w �,_." �i t�'2
Manufactured Home Padc Lots $25 3�1
Recreatlonal Vehicle Park Sit� $5 � ' , / � v3 �
Se ' I on $ZO
S Ins 'on @,$30 per Hour � °ATE
Special I� on @$.31 per Mile ----+
THIS INSTALLATION AAAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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�' Rough-In Inspecdon Requtredl es ❑ No Insp�lion Other Than R
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You must cell the inspectnr when readyl Date Ready.
I certify that I am the ENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
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