P - 78703REQUEST FOR ELECTRICAL INSPECTION
1�A4 2 2���� � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
/ (651) 642-0800 T'fY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW EMODEL 0 ADDITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the work covered by this request:
#45469 Insp; Bob Clausen Install new 100a, 120v sin le hase s
GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES � Traffic Sional Standard (d S5
0
VIRV V I I J I �CCU[RJ Transformer I Power Su I for Si ns / Outline Li htin $5
0 to 200 Am re $5 �,t ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Senice and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Txro InspecGon Trips Each Dwelling Unit @ a80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS and�nnnai io��nr,� r��� u� ��n
i irnmai vvr��urvua rtK Un� � TOTAL FEE
3 to 12 Units � a50 Per Unit (minimum total f22 is $20) �. �j0
E�hAddi6onalUnit�$25 THISAREqFqtINSfFCTORUSEMY �
1 hereby cer6y that I in�� /� m a6on described herein an tlie da�s st�ed:
OTHER ADDITIONAL FEES fs/^�Ni�t +-+[.�i ��C%�i
' h6n Retrofit $.25 r Fixture
Cenler Pivol Irriaation Boom ��d0 R� �+ wre
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neques� uace: Rcugh�n Inspection Required? ❑ Yes � No Inspection Oth� Than Rough-in: ❑Ready Now � Will Call
4�23�03 You must call the inspeGOr when ready! Date Ready:
i certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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