P - 77712p REQUEST FOR ELECTRICAL INSPECTION �"��
1� Q 5 g�' � 7 5� Minnesota Board of Electricity ��� v'a�Q �- � :�
�y 1821 University Avenue Suite S-128, Sai au , Minnesota 1�4 �`
✓I �Y�`i L �.� J'� � �(651) 642-0800 TTYIMRS 1-800-627-3529 www.electricity.state.mn.us
Describe -usin the back of the white copy if necessary - the work covered by this request:
IYIUI� ���ll�rl ('��A1_ � .��ih� ✓> t�I/�Pn�l A�i.F )
SUPPLIES
0 to 400
401 to 8�
Above 8
FEES
RM, COMMUNICATION, REMOTE CONTROL,
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
TIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units (� $50 Per Unit
FEES
�fit @ $25 per Fixture
Irrigation Boom @ $4(
i Home Park Lots @ $
Vehicle Park Sites (d
HIS INSTALLATION MAY BE
,� �
I li�i II III II I(I il Iil il I�i II III II ill II III �� I�
L8591750
1
Tra�c Siqnal Standard
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins tion Tri s $20
Investigative Fee
Reins ection Fee $20
TOTALFEE
(minimum total fee is $20)
THIS ARFA fOR INSFECTOR USE ONLY
I hereby ceAity that I inspeded the electrical installation descnbed herein on the dates stated:
c-.. /�� � )
DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
Date: ,�/''� Rough-in Inspection Required? ❑Yes o Inspedion Other Than Rough-In: eady Now ❑ Will Call
� (/�J You must cail the inspector when ready! Date Ready:
I certify that l am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at