P - 76151p REQUEST FOR ELECTRICAL INSPECTIORI W'
2� o O�� 0 9 5� Minnesota Board of Electricity
1821 UnNersity Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Describe -usir�g the lmck of the white copy'rf nece.ssary - the xrork covered by this requast:
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s- GENERAL FEES Outdoor LiuMhm Standard (dD $1
Transformers over 10 KVA $ 20
Transfortner / Power Suppry for Signs / Outline Ltghting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Irtcludes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspectfon Trips Each Dweuir�g Unit �$80
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Apparatus (a� $.50
ADOffIONS TO THE GENERAL FEES
Cemer Pivot Irripation Baom
THIS INSTALLATION MAY BE ORDERED-
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20870952
TOTALFEE
Inimum total fee is $20) Z �, r—
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I Inspeded fhe electriml Insfellation desxibed frerein on the dates st�ed:
IF NOT
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��� Rough-In Inspec4lon RequiredT ❑Yes �No Inspec1lon OtliarThan Rough-In:� Ready Now ❑WIA Call
(�`�1(7� You muat ce0 the inspector when ready! Date Ready: � �' SI (� �p
1 ceRify that I am the ICENSED CONTRACTOR ❑ COMPRNY ❑ OWNER and hereby request inspection of the electrical work at
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