P - 79083(� REQUEST FOR ELECTRICAL INSPECTION
1� 6 21.� J� 0 � Minnesota Board of Electricity
1821 University Avenue Suite -128, Saint Paul, Minnesota 55104
• (651) 642-0800 TfY/MRS -SO 27-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR, � sCribe -usin the back o e copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li h6n Standard $1
SERVICES I POWER SUPPLIES Tratfic Signal Sta�dard @$5
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
to 12 Units
Lighting Retrofit @ $.25 per I
Center Pivot Irriaation Boom
S iallns 'on $30 Hour
Spacial Inspection � E•31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCOh
Il�l Illll IIIII IIIII Ilill IIIII IIIII IIIII UIN II�
1621980�
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Cirouits and Txro Inspec6on Trips Each Dwelling Unit @$80
(minimum total fee is $20) I�"�' � U
THIS NiEA FOq HbPECidt Of1Y
I hereby cerfiry that I inspecEed ihe electric� installaAOn desaibed herein on the dales sfa�d:
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Req Rough-in Inspection Requiredl ❑ Yes
You must call the inspedor when readyl
I certify that I am 1he LICENSED CONTRACTOR OCOW�ANY
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Ir�pection Olher Th� Mn: ❑ W01 Call
Date Ready: �
❑ OWNER and hereby uest nsoection of the electriql work at:
Ja�Site Address (${reeL Box, a Rate No.} _ CiIY ��. ' .�
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OF ELECTRIdTY CAPY
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EB-00001Mi4 8.1.2002