P - 77680REQUEST FOR ELECTRI L IN PECTION '�
� ��8 � 9'� � � � � Minnesota Board of Electricity �� (/
1821 University Avenue Suite S-128, aint Paul, Min��04
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERA FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic S' nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re$75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transfomier I Power Su I for S' ns I Outline Li htin $5
0 to 200 Am re $5 — ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwetling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20
Each S stem Device or paratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee $20
MULTIFAMILY DWELLINGS PER UNIT `_ ,_ J� _, � TOTAL FEE
3 to 12 Unfts @$50 Per Unit N�•�"ri� imum total fee is $20) 3�' ��
EeCh AddRiOnel Unit @$25 iMIS FREP fOR INSPECTOR USE ONLY
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 per FiXture I hereby cenify that I inspected the elecVical installation desaibed herein on the dates stated:
Center Pivot Irrioation Boom an 840 RWGHIN op,�
S ialln,
THIS INST.
Lots $25
Sites $5
on $20
r Hour
r Mile
MAY BE ORDERED
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18692137
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IF NOT COMPLETED WITHIN 12 MONTHS _____ _I
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°1tl. Rough-in Inspec6on Required? ❑Yes �lo Inspecdon OtherThan Rough-In:�eady Now OWill Call
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— v1- �' 0� 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
Job Site Street Address �m,
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TawnshiP Section Range Fire No. Counry
uairty
/ Company
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Nlease Provltle Two (2) Phone Numbers
v�l?Z —781 —�11/�t )
Master Electrician or
License Number
S�1 �7b�C )