P - 78044'] REQUEST FOR ELECTRICAL INSPECTION
1�� J o- 3 5 4� Minnesota Board of ElecUiaty -
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW ❑ REMOD6l O ADDITION R AIR DesaiN-using the bac� e copy 'rf necessary - the work covered by this request:
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GENERAL FEES Outdaor ' htin Staridarcl $1
SERVICES I POWER SUPPLIES r� c�,�� �fa��a�� n cs
0 to 400
401ro8
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Exh System Device or Apparffius $.50
ADDITIONS TO THE GENER4L F
2 Units @ $50 Per Unit
Addition� Unit @ $25
OTHER ADDITI01
ng Retrofit � $.25 per Fixlure
:r Pivot Irtigation Boom � $40
factured Home Park Lots � E
Transformers u to 10 KVA $10
Transfortners over 10 KVA $ 20
Transfortner / Power SuDp�Y fw Signs I OuUine Ligh6nq @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/w Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$BO
Additanal Inspection Tnps . $20
Investigative Fee
Reinsoection Fee � $20
TOTAL FEE �D
(minimum total fee is $20) 4 •
THIS �RFA FOR INSPECiOR USE OrYY
I hereby cer6y that I inspecled the electrical installaGon described herein on the dates sWped:
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rna inaiw�uo►iwn Mp►r aE vRDEKED DISCONNECTED IF NOT COMPLETED WITHIN 12
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�"w'�](��}/��/] Rough�n Inspection Required? ❑ Yes InspeGion Other Tha
I cl lSlI1T �� ya must ca�� the in ''
��v r � � specta when readY! Date Ready:
1 certiy ihat I am the � LICENSED CONTRACTOR ❑ CONIPANY ❑ OWNER and hereby
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of the electrical work at:
Masier tieanc�an or
License Number
7�n-ce2�� �
E&00001M14 8.1.2002