P - 78207Cc"7 REQUEST FOR ELECTRICAL INSPECTION
1� J CJ 1- 0 4 6� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
%_, % 5 3�� (651) 642-080011Y/MRS 1-800�27-3529 www.electricity.state.mn.us
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❑ NEW MODEL ❑ ADDITION D REPAIR Describe -using the back of the white copy'rf necessary - the work covered by this request:
SERVICES I
iMMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
THE GENER4L
3 to 12 Units �$50 Per Unit
Exh Additional Unfl Q $25
OTHER ADDITIONAL
Ligh6ng Retrofit @ $.25 per Fixture
Center Pivot Irrioation Boom � 840
Iliil IIIII ulll illll IIIII IIII) IIIII Iilll �� I�
15670466
'_' / / / �/`t
Outdoor Lighting Standard
Trafic Sianal Standard �
ONE � TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
CircuiGs and Two Inspecfion Tnps Each Dwelling Unit @$80
TOTAL FEE I �
(minimum total fee is $20)
TMIS AREA Fpl NSPECTdt USE plY
I hereby certiry Mat I inspec�d the electrical instaXation described herein on the d�s st�d:
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)MPLETED WITHIN 12 MONTHS ^
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'�9� �e: Rough�n InspecUon Required? ❑ Yes �(o Inspedion Other Than RougMn: ❑Ready Now Will Call
:� �J��`� You must call the inspector when ready! Date Ready:
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: