P - 75936REQUEST FOR ELECTRICAL INSPECTION °`� .
2 a � � � � � � � � Minnesota Board of Electricity �-:
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 ��' .
(651) 642-0800 T'fY/MRS 1-800.627-3529 www.electricity.state.mn.us
�
D� usin e back of the _' copy n ��t work covered by thf request: �
I /J(� //1�1 �� l.�i/��1�////� �l— l�/1� i�i,c !� �/1 //�rD �'i _ �ii�
�J GENERAL FEES
VICES / POWER SUPPLIES
o to aoo a�, �@$28 . 9
401 to 800 Ampere @ $50
Above 800 Ampere @ $75
;UITS / FEEDERS
0 to 200 Ampere @ $5
Above 200 Am�re @$10
tM, COMMUNICATION, REMOTE CONIROL
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL I
iIFAMILY DWELLINGS (PER UNI'�
3 to 12 Uniis @$50 Per Unft
Each Addftio�l Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 �r Fodure
Center Pivot Irriaa6on Boom [a� $40
Fee
ONE & TWO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Ir�s�on Trips Eacf� Uwetling Unit Q$BO
AddiUonal Inspectlon Trips @ $20
InvesBaative Fee
total fee is $20) 5��.�
TwsavFn�tws�cmausemar. -
80�� n -- �9 �
�L�-`!T+" i i a—��
d fhe elecMcal insla0atlon de�tbed herem on the dat� stated:
l B��
=0R G� �; �': ��S_ p ��v
�II�IIIII�IIIII��l�1111���1�1���1� p �
20192928 a�o�'��,���� �
"""'' Rough-in Inspectlon R�uiredT ❑ Yes � Irrepecdon Other Ro
-f�Y Noev OWtlI Call
You must call the inspector when readyl Date Ready.
I certify that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Sft� , ,
Olrl ?.C�rl � I V �i c�Y/���il
' , C.
mas�er tiewttaan ar
License Number
)
7
.