P - 76211�` REQUEST FOR ELECTRICAL INSPECTION
���� C� � 0 51 � Minnesota Board of Electricity `
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
..� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
-usi the back the w�hite copy ff necessary - the rk cove by this request:
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GENERAL FEES Outdoor Li Standard @$1
SERVICES / POWER SUPPLIES .. �. TraRc Sianal Startdard (�D $5
0 to 400
,UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Each
Pivot Irriqation Boom
Mle
ONE & TWO FAMILY DWELLINGS, EACH UNIT '
Includes the Service and/or Power Supply up to 500 Am�res, All
Circuits and Two Inspection Trips Each Dwellittg Unit @$80
total fee is $20) � i ��
71 LL4 AREA FOR WSPECION IISE 0lbY
d the elecbical inslalladcn d� hereN on the data� atated:
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V Illii �III Ill�i IIIII IIlII Illol III� IIIII 0� I�� o� � D���
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���.�/�/�� Rough-N Inspedion Required? ❑Yes o Inspectlon OtlierThan Rough-In: ❑ Ready Now N Call
� You must cell the inspedor when readyl Date Ready:
I certi(y that I am the �'LICENSED CONTRAGTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecfical work at
Job Site 3treet Addr�s Ciry p
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