P - 78971REQUEST FOR ELECTRICAL 1NSPECTION
1� CJ� �- 3 8 4 8❑ Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 551�4
, (651)642-0800TTY/MRS t-800-627-3529 www.electricity.state.mn.us
❑ NEW �REMODEL O ADDITION O EPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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GENE FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Sianal Standard C� $5
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
fIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Exh Additional Unit Q $25
OTHER ADDITIONAL FEES
Li htin Retrofit $25 er Fixture
Center Pivot Irri aUon Boom �4
ManuEactured Home Park Lo
Recreational Vehicle Park Sites
Se arate Bondin Ins tion $
S ial Ins tion $30 er Hour
S ial Ins tion $.31 er Mile
S INSTALLATION MAY BE ORDERED DISCON
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, Ali
Circuits and Two Inspec6on Trips Each Owelling Unit @$80
Addi6onal Inspection Trips @ $20
InvestiaaGve Fee
(minimum total fee is $20) "F Vb
THIS MEA Fqi INSPECTIXi lISE pdV
I hereby certiy Mat I inspected the electrical insWlt�on descnbed herein on the dates sfa0ed:
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Request te: Rpughin Inspeclion Required7 Yes ❑ No Inspec�on Other Than Rough-In: �Ready Now Will Call
��, V� You must call the inspector when readyl Date Ready.
I certify that I am the �ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hemby request inspection of tl►e electrical woric at:
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EB•OOOOtA-74 8.7.2002