P - 78138� REQUEST FOR ELECTRICAL INSPECTION
1� 5 6 4���� j't j Minnesota Board of Electriaty
L J 1821 University Avenue Suite S-128, SaiM Paul, Mi 55104
(651)642-080011Y/MRS 1-800-627-35�9 r ity.state.mn.us
❑ NEW ❑ REMODEL O ADDITION ❑ REPAIR Degcribe: using the back of the whit�opy'rf n� - ork covered by this request:
SERVICES /
)MMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS Of LESS THAN 50 VOLTS
iystem Device or Apparatus � $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Exh Additional Unit @ $25
Ligh6ng Retrofit @ $.25 per Fixture
Center Pivot Irrigation Boom @ $4C
Manufxtured Home Pazk Lots �? $
Recrea6onai Vehicle Park Sites � ;
Transfortners u to 10 KVA $10
Transformers over 10 KVA (� $ 20
Transiormer I Power Supply for Sipns I OuUine LighGnq .$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Tvro Inspec6on Trips Each Dwelling Unit � S80
Fee
(minimum total fee is $20) � �J � —�`�
iH15 MEA FOR INSPECip2115E Cf1Y
I hereby certify Mat I inspected the electrical insWl�on described herein on the dafes stated:
115 INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETEI
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I certify that I am
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Rough-in Inspection Required? LJ Yes �I_IIYe, Inspection Other Than Rough-In ady Now ❑ Will Call
You musl call the inspector when ready! Date Ready:
NSED CONTRACTOR ❑ COMPANY ❑ OWNER , and hereby request inspection of the electrical work at::