P - 78234REQUEST FOR ELECTRICAL INSPECTION
�� 4 C� 2— 2 3 7 � Minnesota Board of Electriciry -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of ►he white copy if necessary - the woric covered by lhis request:
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GENERAL FEES Outdoor Li htin Standard St
SERVICES / POWER SUPPLIES Traffic Sinnal CtandarA !rl t5
iM, COMMUNICATION, REMOTE CONTROL,
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @ 5.50
ADDITIONS TO THE GENERAL F
fIFAMILY DWELLINGS (PER UNIn
3 to 12 Units � S50 Per Unit
Each Additional Unit @ E25
OTHER ADDITIONAL FEES
Lighting Retrofit @ E.25 per Fixture
Center Pivot Irrroation Boom � S40
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14922371►
� Transfortners up to 10 KVA @ S10
� Transformers over 10 KVA �$ 20
Transfortner I Power SuDD�Y for Signs I Oulline Lighting � a5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @ E80
Reins 6on Fee 520
TOTALFEE r� �
(minimum total fee is $20) p�S �J � 5
r1M5 nREA Fat xsFEtTdi usE aar
I hereby cer6ty tl�al I inspet0ed the ekti6ital insta8ation described herein on the da�s stffied:
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L�y� ���� Roughin Inspection Required7 U Yes �1�b InspeUion Other Than Ragh-In: ❑Ready Naw ❑ Will Call
vYou must call the inspecla when ready! �' Date Ready.
I certiTy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecfical work at:
Job Site Address (SUcet Bwc. or Roule No.) CiH Z�p Code
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�5 -ft/Gt rm ,�n c � CGo o i l I
ess (Contrada, Company or Owner Performing Installation)
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w7NS ON BACK O�ELLOW GOPY / BpARp pF ELECTRICT' COPV
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mas[er r�acvician a
License Number
/ SS 337
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EB-0OOO1M1� 8.1.2002