P - 789431- 6 7 4- 3 6 2� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, ' sota 55104
�+ (651)642-0800TTY/MRS1-800�'i27-3529 tncity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITION REP IR DASCri using the back of the white copy if nec ary - the work covered by this request.
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Outdoor Lighting Stand
Traffio Sianal Standard
0 to 400 Ai
401 to 800
ONE 8� TWO FAMILY DWELLINGS, EAGH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuiis and Two Inspection Trips Each Dwelfing Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Anuaratus �$.50
3 to 12 Units �,1$50 Per Unit (minimum total fee is $20)
EachAdditionalUnit@$25 r��sanEaFOaiwsaECr«eusEOrar �
I hereby ceNty tlwt I inspec0ed tl�e elec6ical insUllabon described herein an the da�s st�ed:
OTHER ADDITIONAL FEES Z �.�- �_ G��- cf �
' htin ReVOfit $.25 r Fixt�re
Center Pivot Irri ation Boom $40 �"'" °"rE
Manufactured Home Park Lots S
Recreational Vehicle Park Sites F1°` N5PEC10N wrE
Se arate Bondin Ins tion $20 I L_,, 2_ e
S � InS 'Otl 830 HOUr e�oi�a�warEO wTe
S ial Ins 'on $.31 r Mile
THIS iNSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Req Rpughin Inspec[ion Required? ❑ Yes - {nspedion Other an gh-1 Q Will Call
You musl call the inspector when ready! Date Ready.
I certify that I am 1 s�ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and here ►eq t inspection of the elecUical xrork at: