P - 77647REQUEST FOR ELECTRIC L INSPE TION
1��' 4 41 —� o O � Minnesota Board of ElecUicily ��'— ,3��/
1821 University Avenue Suite S-128, SaiM Paul, Minnesota 551�D4
(651) 642-0800 TTY/MRS 1-800-627-3529 www.e[ectricity.state.mn.us
❑ NEW ` REMODE ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERALFEES
JICES / POWER SUPPLIES
0 to 400 Amcere � E25
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
FEES
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irrivation Boom Cal E4(
IIII IIIII III�� IIIII I�III IIIII IIIII IIIII �� I�
14413009
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Su lemental Fee 52(1 i
Transfarmers u to 10 KVA �$10
Transfortners over 10 KVA $ 20
Trarisfonner / Power Su fw S' ns I OuGine Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspec6on Trips @ $20
Investiaative Fee
TOTAL FEE I � �
(minimum total fee is $20) �
THIS MEA FIXt 1115PECi0R USE qdY
I hereby certify that I inspecfed the eletbical instaNafion destribed herein on the dffies staled:
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rcequest ate: gh-in Inspedion Required? ❑ Yes � No Inspection Other Than R h-In: �teady Nuw p VNII Cali
� ��ilv You must call the inspector when ready! Date Ready: ��2,, 6! O,�
I ceAify that I am the ❑ LICENSED CONTRACTOR 0 COMPANY ❑ OWNER and hereby request inspection of the elechical work at:
iMSmuc-,uMS oN ewcK oF reLLOw corr BOARD OF ELECTRICRY COPY ee-0000in-u e.�. �