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