P - 76298�: �
° REQUEST FOR ELECTRICAL INSPECTION
1�( 9�- 5 4 2 6 Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' . (651) 642-0800 T1Y/MRS 1-800-627-3529 www.edectrdcity.state.mn.us
�sGribe -using the back of the white copy'rf necessary - the work covered by this request:
E�CEL E6�E�iGY SAtJE�i'S Si�1TCH
)MMUNICATION, REMOTE CONTROL, SIGNAL
CIRCt11TS OF LESS THAN 50 VOLTS
iystem Device or Apparatus @ $.50
ADDRIONS TO THE GENERAL FEES
1Y DWELUNGS PER UNIT
Units @ $50 Per Unft
�ddiUonal Unit @ $25
OTHER ADDITIONAL FEES
Retrofit @ $25 per Fixture
Pivot Irrigallon Boom @ $40
achired Home Park Lots $25
�tional Vehicle Park Sftes $5
ite Bondinc Ir�s ection a$20
1 Inspecfron @ $30 er Hour
I Inspectlon @ $.31 per Mile
>TALLATION MAY BE ORDERED
Standard
Fee a(� $
� Transformer I Power Supply for Signs I Outline Ligh6ng @$5
ONE 8 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 (cD $20
TOTAL FEE I
total fee is $20) �� ��'
I inspected the electrical Installation described hereln on fhe dates siated: I
IF NOT COMPLETED
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�' Raugh-in Inspection Required? ❑Yes � No Inspection Other Than Rough-In: �Ready Now �Will Call
�� �� J� � You must call the inspector when readyl Dete Ready:
I certify that i am the �I LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Slle Street Address C�,
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Please Provide Two (2) Phone Numbers Inciuding
\ / \ /
wnuoµw � winpany rvarrre contrac[or License Number Master Electrician or P
. NUhlT ELE� I�IG CQF�:F't�Fi�`rTI!71�1 �� ����� LlcenseNumber
Mai!!ng Address (Contractor, Company ar Ovmer Performing Installadon)
�3t7ti TEF.F:TTGR��L. f;OFtUq Sr�Thli F'�ULq f�ih� 5�i1�?
/iutlmriz� Slgrmture (Contractor or Owner Performing Installatlon) Please Provide Two (2) Phone Numbers I
�i5� �5�b—L911 � �
IN$IRUCTpNS ON � CK OF YELLOW COPY BOARD OF ELECTRIGTV COPV