P - 77032REQUEST FOR ELECTRICAL INSPECTION
1� b 9��� 7 8 � Minnesota Board of Electricity �j�/`ZS. D��rjQ
1821 University Avenue Suite S-128, S i��`aul, Minnes S�Od
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electriciry.state.mn.us
❑ NEW REMODEL t❑ ADDITION ❑ REPAIR Describe -usiwg the bxk of the white copy 'rf necessary - the,�o[k cG �ed b�tl�� •
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2M, COMMUNICATION, REMOTE CONTROL, SIGNALING
;UITS, CIRCUITS OF LESS THAN SOVOLTS
Each System Device or Appaatus @ E.50
ADOITIONS TO THE GENERAL FEES
TIFAMILY DWELLINGS PER UNI
3 to 12 Unils �$50 Per Unil
Exh Additional Unit @ $25
OTHER ADDITIONAL FEES
' hGn Retrofit $.25 er Fix►ure
Center Pivot Irri ation Boom y10
Manufactured Home Par1c Lots @ S25
I I� II III II III II III II III I) (II (I II� �I III �I� I�
16929788
Traffic Signal Standard
Suoolemental Fee C� $
Includes ihe Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE
(minimum totai fee is $20) �e• '
TWS �REA Fqt IISPECTOR USE OMY
I hereby cer6y Ihat I inspecfed the ekctrical installa6on described herein on the dates staled:
neq� t u e: Rough-in Inspection RequiredT �Yes ❑ No Ins . l
���� j pedion Othw Than Rough-In: ❑Ready Now Will Call
�/O You must caN the inspector when ready! Date Ready: . I
I certify that I am �e �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec.•tion of ttie elecbical work at:
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