P - 78994REQUEST FOR ELECTRICAL INSPECTiON
1"�� O- 6 7 9 4� Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
' (651) 642-OB00 TfY/MRS 1-800-627-3529 www•e[ectricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR Describe -using the back of the whit�CCOpy if necessary - the work covered by this request:
Ne� �'ov ct v� ove f%a Se�r/iG-e
GENE FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Tratfic Si nal Standard $5
0 to 400 Amoere (a? $25 f„„ DrD Su lemental Fee $20
f ALARM, COMMUNICAT{ON, REMOTE CONTROL, SIGNALING
� CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
�T E�h Svstem Device or Apoaratus @$.50
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER AD
Ligh6ng Retrafit @ $.25 per f
Center Pivot Irriaation Boom
S ial Ins �on $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DI:
NIII II1111111� Iilli 1111111I1f Ilili IIIII hi� I�
14506794
Transformers over 10 KVA 5 20
Transformer / Power Supply for Signs I Oulline LighGng @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Tvro i�spection Trips Each Dwelling Unit @$SO
TOTAL FEE I
(minimum total fee is $20) �Q, �C�
THIS MEA FOR INSPECTpt USE CMY
1 hereby cer6ry that I inspected the electrical insWlation deuribed herein on the dates sfa�d:
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K�9�� ��e: Rough-in Inspection Required7 U Yes � Inspection Other Than Rough-la:�y Now�VO� Call I
6�� Q� Yai must call fhe inspector when readyl Date R�dy: 6` 6� 6 '�
I cerMy that I am tl�e �CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby �equest inspection of the electrical work at:
Job Site Address (Sheet Box, or Route No.) ZiP Code
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BACK OF YELLOW COPY /�RO OF ELECTRICIT' COPV
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ber Master Electridan or Power L'united
� License Number
Phone (s) �—
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