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P - 77689�' r^T"IC. INSPECTION � REQUEST FOR �� P�,1� � y�� �� 1 � c7-1 � -18 5 � Minnesota Board of Electricity ��QQ � � � : 1821 University Avenue Suite S-128, Saint paul, inne a 51 �' (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us Describe -using the back of the white copy if necessary - the work covered by this request: �i.�T�- Tisv,e/�- S1i�x ,�.4.rr.�a� S� ERVICES I POWER SUPPLIES 0 to 400 Amcere C�D $25 Above 200 Am ere a$10 ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING CIRCUITS, CIRCUiTS OF LESS THAN 50 VOLTS 3 to 12 Units @$50 Per Unit Each Additional Unit @ $25 OTHER ADDITIONAL Lighting Retroft @ $.25 per Fixture Center Pivot Irriaation Boom C�D $40 Hour Mile ���� �� ��� �� ��� �� ��� �� ��� �� (�� �� (�� �� ��� � � � � 19L31853 Traffic Sianal Standard Transformers over 10 KVA $ 20 Transformer / Power Su I for Si ns / Outline Li htin $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit @$80 Additional Ins ion Tri s $20 Investigative Fee Reins ion Fee $20 TOTAL FEE s (minimum total fee is $20) -� �� � THIS AREA FOR INSPECTOR USE ONLY I herebv certifv that I insoected the elecVical installation desaibed herein on the dates stated: CTED IF NOT COMPLETED WITHIN 12 MONTHS ____� � ��r, .,. oate: Rough-in Inspectian Required? ❑ Yes �Jo Inspection Other Than Rough-In: ❑ Ready Now � Will Call S�n7,u ' You must call the inspector when ready! Date Ready: I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at