P - 75994REQUEST FOR ELECTRICAL INSPECTION ��
1� 9 7 5�' ��� � Minnesota Board of Eiectricity
1821 University Avenue Suite S-126, Saint Paul, Minnesota 55109
��� (651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
Descri�� �usi�p the back of the wh' ca 'rf nec�sary - the wrork covered by this requ�t:
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GENERAL FEES Outd�r LigMing Slandard @$1
SERVICES / POWER SUPPLIES Trafflc Sipnal Standard C� $5
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Above 200 Am re $10 1�' �- Includes the Service andlor Power Suppiy up to 5�0 Amperes, All
tM, COMMUNICATION, REMOTE CONTROL, SIGNALING Cir�uits and Two Inspection Trips Each Dure�ir�g Und @$BO
:UITS, CIRCUITS OF LESS THAN 50 VOLTS Addfional Irrs 'on Tri $2Q
Each S em Davice or Ap s@$.50 Imestl ative Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee $20
TIFAMILY DWELLINGS PER UN TOTAL FEE
3 to 12 Units @$50 Per unit (minimum total fee is $20) ���
Each Additional Unit � $25 T19SA�''�1°'�'�'�0"°��
OTHER ADDITIONAL FEES
� htirtg Retrofit @$.25 per �ixture _ .! heca6y cerMy that l Nspeded t#re elestrical mstalladon d�aibed h�eh�omtdeda�s s�ed; -
Center Pivot Ir� on Boom @$40 R01°'�' °ATE
Sftes
'ALLATION AAAY BE ORDERED
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19756311
cCTED IF NOT COMPLETED WITHIN 12
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"""'� Rou h-in Ins on R uired? ❑Yes �jrlo I�
g pecti � pection Other Than Rough-In: ❑ Ready Now ill Call
���� °' � You must'cell U�e inspector when ready! C` Date Ready.
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hareby request inspection of the electrical work at
J� �� Address� � l�1 l 1 . C�I� V' l Cl 1� 2.�
MN
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License Number
/1
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Area