P - 77607REQUEST FOR ELECTRICAL INSPECTION �F"
1-86�-875 4 � �}�
� Minnesota Board of Electricity �/1/�� .r��,�!/ a :�,
1821 University Avenue Suite S-128, Sa(rtf�aul� innesota 551a4 �'
�'� �` f (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ���
Describe -using the back of the white c if necessary - the work covered by this request:
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✓ICES / POWER SUPPLIES
0 to 400 Ampere C� $25
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units an $50 Per Unit
Center Pivot Imgation Boom �
Manufactured Home Park Lots
Recreational Vehicle Park Site:
Special Inspection $.31 er Mile
THIS INSTALLATION MAY BE ORDERED DISC
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18688754
Outdoor Lighting Standard
Traffic Sianal Standard la�
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 50p Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additionallns tionTri s $20
Investi ative Fee
Reins ection Fee $20
TOTAL FEE 5
(minimum total fee is $20) � '—
THIS AREA FOR INSPECTOR USE ONLY
I hereby certiry that I inspected the electrical installation described herein on the dales stated:
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JIPLETED WITHIN 12 MONTHS
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Date: Rough-in Inspection Required? ❑Yes �o Inspection Other Than Ro�gh-In: ❑ Ready No Will Call
�—� 1��� You must call the inspector when ready! Date Ready:
� certi(y that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at