P - 78988REQUEST FOR ELECTRICAL INSPECTION
�.. �• �F J 4� 8 8 1 � Minnesota Board of Electricity -
1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us " "'
❑ NEW ❑ REMODEL ADDITION O REPAIR Describe -usin the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdaor Li htin Standard $1
SERVICES I POWER SUPPLIES Traific Sian� Standard � ES
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus � 5.50
Center Pivot
Fixture
Mile
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14548812
10 KVA
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andla Power 5upply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @ E�
TOTAL fEE I � f.� �—
(minimum total fee is $20) (,%. �
TWSARE�Fqtl CTORUSEOILY
I hereby certiry thal I inspecOed the dectrical instaN�on described herein on the da�s s�ed:
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CONTRACTOR ❑ COb�ANY ❑ OWNER and hereby request inspecfion of the electrical work at:
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