P - 78058REQUEST FOR ELECTRICAL INSPECTION �� ,
1����-13 8� Minnesota Board of ElecViaty -
�, 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T7Y/MRS 1$00�27-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ AD ION ❑ EPAIR Descri -using the back of the white copy 'rf necessary - the work covered by this request:
1MMUNIGAI ION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
�ystem Device w Apparatus @ SSO
ADDITIONS TO THE GENERAL FEES
3 to 12 Units � y50 Per Unit
Each Addition� Unit @ S25
OTHER ADDITI01
Lighting Retrofit � $.25 per Fixlure
Center Pivot Irtigation Boom 540
M�ufactured Hane Park Lots � E
Recreation� Vehicle Pak Sites � ;
Outdoor
� Transfamers uD ro 10 KVA �$10
� Transformers over 10 KVA � S 20
_ Transfortner I Power Supply for Sipns I OuUine Liahting �5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service �dlor Power Supply up to 500 Amperes, All
Circuits and Txro Inspection Trips Each Dwelling Unil @ S80
Fee
Fee
TOTALFEE
(minimum total fee is $20) �Q . ��
THIS ARFA Fqi INSPECTOR USE Of�IY
1 hereby ceAiy that I inspected the electrical installatipn described herein on the da0es sUOed:
FEES ��c�_ (L-ro-��
� n�a ir�a i A�ua i iun �xn� e3t UROEiZED D15CONNECTED IF NOT COMPLETED WITHI
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Request pate: F2ouy►rin Inspecfion Required? ❑ Y� � No Ins
O• �O _ O� paUion Other Than RougMn: Ready Npw O V1f11 Call
� You must call the inspector when ready! Date Ready:
I certify that I am the L�CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he►eby reyuest insspection of 1he electriql work at:
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