P - 77203REQUEST FOR ELECTRICAL INSPECTION
1� 4 71- 6 21 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651)642-080011Y/MRS 1-800-&27-3529 www.electricity.state.mn.us
❑ NEW MODEL O ADDITION ❑ REPAIR Describe -using the bxk of ihe white copy'rf necessary - ffie work covered by this request:
I E � � �
GE L FE S Outdoor Li n ar�dard $t
SERVICES I POWER SUPPLIES Traific S' n� Standard ES
0 to 400 Am re$25 Su ntal Fce E20
401 to 600 Amcere � E50 Transiortners uo to 10 KVA � S10
RS
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Exh S stem Device a us E.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each AddiGonal Unit � 825
OTHER ADDITIONAL
Lighting Rehofit � 5.25 per Fixture
Center Pivot Irtiaation Boom � $40
IliIiIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIN�Ii�I
14716211
Includes the Service andlor Power Supply up to 500 Amperes, All
Cirouits and Two Inspecfion Trips Each Dweliing Unit @$BO
TOTAL FEE I f ,S /,I
(minimum total fee is $20) �,�'y
TIpSNtEAfORINSPECTORUSEMY �
I hereby cer6fy thM I inspecBed the elecbical instaqaAon despibed herein on the dales stated:
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_ �
�Q'�1 �/1e: , Rcwghin Inspedion Required't ❑ Yes �,�l0 6upectiai Olher Than Raugh-In: ❑Ready Now�ll Call
/ 1•- /� ��yf You must call the inspecta when ready! Date Ready:
6��' ' /
I certity that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: