P - 78069REQUEST FOR ELECTRICAL INSPECTION
1�.3 ��° 5 9 5� Minnesota Board of ElecVicity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
._ (651)642-0800TTY/MRS 7-800-627-3529 www.electricity.state.mn.us
�dEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back oi ihe white copy if necessary - ihe work covered by this request:
SERVICES /
tM, COMMUNICATION, REMOTE CONTROL,
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL F
fIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units �$50 Per Unit
Each Additional Unit C� S25
Lighting Rehofit
Center Pivot Irri
Mile
I�II � IN il lll II III II I I I h�l II III II III I� I�
15335953
Outdoor Liqh6na Standard
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All $ 5
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Fee
Fee
(minimum total fee is $20) � 8 5. 5 0
THIS AREA FOR INSPECTqi 115E Of1V
I hereby certify tl�at I inspected 1he electrical insfalla6on descnbed herein on the dates stafed:
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neques[ ua[e: Rough-in Inspection Required? �Yes ❑ No Inspection Other Than Rough-In: ❑Ready Now O Will Call
1 0— 21 — 0 3 You must call the inspeclor when ready! Date Ready:
I certify that I am the ,�C`CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::