P - 78382REQUEST FOR ELECTRICAL INSPECTION
1,� 5 0 2- 3 4 0 � Minnesota Board of Electricity -
1 University Avenue Suite S-128, Saint Paul, Minnesota 55104
642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ION REPAIR Describe,/sin e back of the white copy if necessary - the work covered by this request:
Aa
GENERAL F Outdoor Li h6n Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Amcere (a) $25 Supplemental Fee @$20 _
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
fIFAMILY DWELLINGS (PE
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Center Pivot Irciqation Boom
II�I) �III� I��II I�III IIIII IIIII (I�II II�II II� (�
15023401
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Tnps Each Dwelling Unit @$80
Additional Ins 6on Tri $20
Investi ative Fee
Reins tion Fee $20
TOTALFEE �/�
(minimum total fee is $20) Q• V �+
T HIS MFA FOR INSPECTpi USE IX1Y
I he2by ceNry thal I inspecled the electrical imtalla6on described herein on the dales sta�d:
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ReQues►� : Rough-in Inspection Required? ❑ Ves LJ No Inspedion Other Than Roughdn: Ready Nbw ❑ WiN Call
�� ��� You must call the inspector when ready! Date Ready. _
I certiy tliat I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecfical work at:
Job Site Address (Street, � or No.) /� Zip Code
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EB-OOOD1M74 8.1.2002