P - 75625REQUEST FOR ELECTRICAL INSPECTION
i� a� �� 6 2 9� Minnesota Board of Electricity
1821 University Avenue Su�'ie �-1�8,'�aint Paul, Minnesota 55104
��j��.— ��� ,�!851) 6�2-0800 TTY/MRS 1-500-627-3529 www.edectricity.sdate.mn.us
'-us��'n9 tl�re �acic of th� Ite copy if n�ry - the work cov�d� th' requ�t:
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ENERAL FEES Outdoor Lightin Standard $1
ES / PQ�ER SUPPUES Traflic Sinnal Standard CD. $5
200 Am re $10 Irtcludas the Service andlor Power Supply up to 500 Amperag, All
)MMUNICATION, REMOTE COIdTROL, SIGNALING Circuits and Two Inspection Trips Each Dwenirtg Unit @$SO
CIRCUITS OF LESS THAN 50 VOLTS Addibonal Ir�s 'on Tri $20
iystem Device or A s$.5D Imesti ' e Fee
ADDffIQNS TO THE GENERAL FEES Reins 'on Fee $20
ILY DWELLINGS PER UN TOTAL PEE . ��j��
! Units @$5o Per Unit (minimum total fee is $20) J v
�dditi�onal Un@ @ $25 nasar�aFOauave�croaugaar
OTHER ADDITIONAL FEES
RefrOfit @$25 r FDdUre I hereby certHy tlmt I inspected tlie electrical hustallatlon d� herein nn tlte dates sfe�d:
r Pivot Irti 'on Boom @ $40 �1°' �' _ °ATE
ectured Home Park Lots $25 �—�' �.G
�tional Vehicle Park Sit� $5
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on $.31 rM�e
1LLATION MAY BE ORDERED DISCONNE ED IF NOT_ COMPLETED WITHIN 12 MONTHS__ �___ _
' . '_ _' _'_'_—___ ___ _ ` `_ ` __' �OR OP`)CE USE GNL'r ��(,�„�
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Rough-in Inspedion Requir�7 es ❑ No Inspedion Otlier Than Rough-In: �Ready Now ❑ W01 Call
You must cell the inspec[or when readyl Dete Ready: `� `�
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VSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspedion of the electrical work at
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EB-00001M15 8.1.2004