P - 78039REQUEST FOR ELECTRICAL INSPECTION
�� 5 4 4- 6 2 8� Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
�� �( a'� (651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW
GENERALFEE
JICES I POWER SUPPLIES
0 to 400 Amcere � 525
❑ REPAIR Describe -using t �back of the white copy if necessary - the woric covered by this request:
�c Clc'5\ � S�l�' OI ��,o
S Outdoor Liahtina Standard (� S1
ALARM, COMMUN�CATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus 5.50
ADDITIONS TO THE GENERAL F
� Transformers up to 10 KVA $10
� Transformers over 10 KVA (a� $ 20
Transfortner / Power Supply for Sians / OuUine Lightinq .$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, AII
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips . $20
Investigative Fee
Reinscection Fee C� $20
�MMILT UYY[LLIIVUJ rrrc uni i TOTAL FEE
to 12 Units @$50 Per Unit (minimum total fee is $20) �. �
eCh Addi6onal Unit @�25 rws nnEn Fa� ir�saECTOrs usE aar
I hereby certiy that I inspected the elec6ical insfallation described herein on the dates stated:
OTHER ADDITIONAL FEES � K_�. ia -Y% y
h6n Rehofit E.25 er Fixture
enter Pivot Irri ation Boom $40 R01�"'" o�Te
lanufactured Home Park Lots $
ecreaGonal Vehicle Park Sites "`°`�'�" wre
arate Bondin Ins tion $20 �-S—C`�
DMPLETED WITHIN 12 M
IIIII II� (IIII IIII) IIIII II��I IIIII IIIII II� IINI ��► 5r �7
154462B9 ��'��g ao��
nequesc uace: Rough-in Inspection Required? ❑ Yes �NO Inspection Other Than Rough-In: ❑Ready Now Will Call
� 1—`� `�� You must call the inspector when ready! Date Ready:
I certify that I am the �(ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::