P - 76877REQUEST FOR ELECTRICAL INSPECTION �"�
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� Minnesota Board of Electricit t �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �.
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us ��»s,��
Describe -using the back of the white copy if necessary - the work covered by this request: aQQ P
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GENERAL FEES Outdoor Li hting Standard @$1
SERVICES / POWER SUPPLIES �„ Traffic Siqnal Standard fa� $5
401 to 800 Am ere $50 '
Above 800 Am ere $75
CIRCUITS I FEEDERS
`� 0 to 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit l�D $25
Irtigation Boom @
f Home Park Lots (
Vehicle Park Sites
INSTALLATION MAY BE ORDERED [
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18204313
� Transfortner I Power Supply for Signs / Outline Lighting @$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
Additional Insoection Trios a(� $20
TOTALFEE
total fee is $20) �� l� sa
I hereby certify that I inspected the elecVical installation described herein on the dates slaled:
RWCaHIN . DATE �y
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FIN4LINSVECT10 ��'+ � � '�� pqTE �
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F NOT COMPLETED WITHIN 12 MONTHS
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Date: Rou h-in Ins ection R uired? ❑ Yes ❑ No lns
� 9 p eq pection Other Than Rough-In: ❑ Ready Now OWill Call
�— �' You must call the inspector when ready! Date Ready: -
I cerrtify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address . ��y �
Nl�r�u c �2tr� �' /e
ownship Section Range Fire No. County
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Address (Contrador, Company or
riease Provide 7wo (2) Phone Numbers Including Area Code
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Master Electrician or
License Number
gna (cont or or Own rtortning Installation) .. Please Provide Two (2) Phone Numbers Including Area Code
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ON BACK F YELLOW COPY BOARD OF ELECTRICITY COPY Ee-OOOOtn-�5 a � �nm