P - 79233, REQUEST FOR ELECTRICAL INSPECTION -
��� C�� c G/� � Minnesota Board of Electricify ;-
� �J �a �f 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, (651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITION_ 0 REPAIR rDescribe -y�iqqjhe b,�ck of the white copy if necessary - the work covered by this request:
SERVICES / POWER SUPPLIES
0 to 400 Amcere Ca� $25
tM, COMMUNICATION, REMOTE CONTROL, SIGNALING
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDI710NS TO THE GENERAL FEES
fIFAMILY DWELLINGS PER UNI
310 12 Units @$50 Per Unit
Each Additional Unit � $25
Center Pivot Irtigation Boom �a
Manufactured Home Park Lots
�
Outdoor
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Supply for Si9ns I Oulline Lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, Atl
Circuits and Two inspeclion Trips Each Dwelling Unit �$8Q
(minimum total fee is $20) I �0.50
THIS PRE� FOR Il15PECTOR USE IXdY
I hereby certity that I inspecled fhe electrical installation described herein on the da0es sf�ed:
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� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITFi1N 72 MONThIS �
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ Inspection Other Tha� Rough-In: ❑ dy Now � Will Call
07��� Vou must call the inspector when ready! Date Ready:
I certify that I am the ❑%�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of fhe elecVical work at:
INBTRUCTONS ON BACK OF VELLOW COP�! BOARD OF ELECTRICITV COPV E&0OOO1M71 8,1.2W2