P - 766101 7 8 7 O 5 7 7 REQUEST FOR ELECTRICAL INSPECTION �
� � Minnesota Board of Electricity �^� ` ` �'
❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �'�
(651) 642-0800 TTY/MRS 1-800-6273529 �atirx.electricitti�.stale.mn.us
Describe -using the back of the white copy if nese6sacy-ihe y!e�l�,sqvefe�.by� y�a4aest: � �� � � i��
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SUPPLIES
to 400 Ai
J1 to 800
AIARM, GOMMUNIGATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus (cil $.50
�
Unit
Liqhtinq Retrofit @ $.25 per Fixture
Center Pivot Irrigation Boom @ $4(
Manufactured Home Park Lots @ g
Recreational Vehicle Park Sites (cil
Outdoor Liqhtinq Standard
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs I Outline Liqhtin $5
ONE & 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
Fee
TOTAL FEE �{).
total fee is $201
the electrical installation described herein on the dates staled�.
Special Ins ion @$.31 per Mile
THIS lN3TALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12
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17870577
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n"' �. Rough-in Inspection Required? ❑ Ye �] No �' Inspection Other Than Rough-In: [�:Ready Now ❑ Will Call
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_ _ _You must call the inspector when ready! I, Date Ready:
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I cQrtify that I am the L�] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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' Job S!1ite Siheet,t�At_ddress + 1 Cityi�C�Ti� !��d ,,S �-�
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,rTownship � '�, Section � i Range I Fire No. � Countv
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� OwnBdOccupant Name � Please Provide Two (2) Phone Numbers Including Area
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I Electrical Utility �, Electrical Utility Address
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, ConUactor / Company Name ��� -� -'. Contractor License Number Ma erst Electrician or Power Limited l
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� MaAirtg Address (Contractor, Company or Owner Performing Installation)
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� AuUarirad S' naturo (Contrac[or or Owner Performing Installation) � - - � � Please Provide Two (2) Phone Numbers Including Area
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INST�CTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRIGTV CoPV ra_nnnn� n_�c