P - 784801°5�0-02� �
� tSCAn � " o (e `i —
GENERAL FE
SERVICES / POWER SUPPLIES
AIARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
LighGng Retrofit � $.25 per I
Center Pivot Imaa6on Boom
Fbw
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627-3529 www.e[ectricity.state.mn.us
� Describe -usin the back of the white copy if necessary - the work covered by this request:
�,nar�.w�o.v�� �,o..�,;�FO QA.n (.
Outdoor Li h6n Standard $1
Traffic Si nal Standard $5
Su lemental Fee $20
Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li h6n $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
tncludes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Ins tion Tri $20
Invesli ative Fee
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20) �
TNIS AREA Fqi INSPECTOR USE ONLY
I hereby certify that I inspected the electrical instaqation desaibed herein on Me da�s smffid:
I�I II III II III II III II IIl II �� In �� a�l I�
1 5 0 0 0 2 8 4
�y50
Requesl Date: Rough-in Inspection Required? ❑ Yes No Ir�pection Other Than Rough-In: �Ready Now Wlq Cadi
9�'Z 63 You must call the inspector when ready! Date Ready:
I certify that I am 1he �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical woiic at: