P - 75628REQUEST FOR ELEGTRICAL 1NSPECTION � �
� � � ��,� � � 4, � Minnesota Board of Electricity ' ` I
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
. (651) 642.0800 TTYlMRS 1-800-627-3529 www.electricity.state.mn.us
Describe -usin�e\ \�tf� de� \�ecessary - e work cov� th's r�uatit:
!J 11�
GENERAL FEES Outdoor Liahtirm Stariddard (a� $1
401 to 800
Atwve 800
�UITS, GIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device orAarnaratus Cd� $.50
TransFormers over 10 KVA $ 2tl
Transformer / Power Supply for Sigr�s / Outlina Lightlng @$5
ONE & 1W0 FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Pamer Supply up to 500 Ampere.s, All
Ctrcuits and Two Inspe�.fion Trips Each Dwelling Unit @$80
W�v +�
TOTALFEE
total fee is $201 ° "
Each Adtfi6'onal Unit (d� $25 '"'""`"'""""�°""""�"'°'
o-M�a�omonu�. �s
' htin Retrofit @$25 per Fodure I hereby el�hical 6�staHaUon d� hereirton the dams staUed:
Cerder Pivot Irti 'an Boom $40 R01Q1 "' °ATE
Manufactured Hortre Park Lots $25 �.'►'--' g.%-- o'�
Recrea6omal Vehide Park Sit� $5 _ �' �j',� a�1 /_ r�,l C
Haur
� fOR OPFtGE USE ONLY
I�IIII�I�III��IIOIiI�I�iIIIIIIIIIO�I� �� JUN��200�
�0�9374�' ���U�1� 200T
�Y;7 � O�
��� Rough-in Inspectlon RequiredT ❑ Yes • � Na Inspedion Other Than Rough-In: � Ready Now �NM Ca�
� You must call the inspector xrtren readyl Date ReadY
I certiifyy that I am the�l LICENSED COMRACTOR ❑ COMPANY ❑ QWNER and hereby request mspection of the electrical wark at
i..ti c�x� c�.m� ena,� a. c�t� y .
� � \ �
Llce�tse N�unber
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