P - 76010REQUEST FOR ELECTRICAL INSPECTION
1 a 9� o� 4 2� � Minnesota Board of Electricity
1821 University Avenue Sufte 5-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTl'/MRS 1-800-627-3529 www.edectricity.state.mn.us
Descrit� -using the back af white py' ec�ssary - th rk covered by this request:
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GENERAL FEES Outdoor Liahtina Standard Ca�
0 to 400
,URS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus (� $.50
Center PivOt ItriAatian Boom
.LATION MAY BE ORDERED �
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1B204263
Tiansformers u to 70 KVA a$10 �
Transfortners rner 10 KVA $ 20 . p
Transformer / Power Supply for Signs / OuUirre Lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits arid Two Inspection Trips Each Dwelling Unit @$80
Fee
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total fee is
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Irerefn on tlre da[as affi�: I
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CTED IF NOT COMPLETED WITHIN 12 MONTHS
F(}R 06�FICE USE ON! Y
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��� Rough-in InspecHon Requtred9 ❑ No Inspedlon Other Than Rough-In: � Ready Now � Will Cell
��� � D You must call the inspedor when readyl Date Ready.
I certify that i am the � LICENSED CONTRACTOR ❑ COMPANY �OWNER artd hereby request inspection of the electrical work at
Job Site Street Addrass Cily
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7
unber Master Electridan or Pawer
Ltceree Numbet'
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