P - 75920REQUEST FOR ELECTRICAL IIVSPECTION
1� 9��� 6 9 0� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mtt.us
D�ibe -using the back of the white copy ff n� - the work cover� by this request:
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�M, COMMUNICATION, REMOTE CONTROL
:UffS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus C� $.50
Each Additlonal Unit @ $25
OTHER ADDff101
LigMirtg Retrofit @ $25 per Fbdure
Center PNot Irtiaation Boom (�D $40
Transformers u to 10 KVA $10
Transfarmers wer 10 KVA $ 20
Transfortner / Power Su I for SI ns t Outline Li hUn -$5
Z� ONE 81UV0 FAMILY DWELLWGS, EACH UNff
Includaa the Service and/or Power Supply up to 500 Amperes, All
Circufts and Two Inspection Tri{� Each Dwei�ng Unit @$80
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immum total fee is $20) 3 a' '�
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I i�eded fhe elechtcal trre�atlun desamed h�ein on dte da0es st�:
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1 THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS ��_
FqR OFFICE USE ONLY
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�: Rough-In InspecUon Required9 ❑ Yes �o Inspecdon Other Than Rough-In�Ready Now ❑ WiA Ca0
� p��� � You must catl tlre inapedor when readyl Date Ready:
I certify that I am tha CENSED CONTRACTOR ❑ COMPANI' ❑ OWNER arid hereby request inspection of the electrical work at
Job Site Street Address ��y
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COPY
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d Addresa
Contrador License Number Masffir Eler.hridan or
r Ll�nse Niunber
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Please ProvMe Two (2) Phone Number
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BOARD OF ELECTRIC COPV
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