P - 76131REQUEST FOR ELECTRICAL INSPECTION � �`,
��� 2 0� 4 7 2 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.stote.mn.us
Describe -using the back afy� �w�h�it�e co if necessary - the work covered by this request: fTc' E d 2 P�C U 6/ /i-N,�
$W� r�uES Fo�e 7�1�- C�l�c �n/6 Ff}N
GENERAL FEES Outdoor Lightin Standard $7
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5 ��� _
.URS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
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Center Pivot IrtlaaUon Boom
LATION MAY BE ORDERED D
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182�4727
ONE & TWO FAMILY DWEWNGS, EACH UNIT
Includes the Service and/or Power Supply up to 5U0 Amperes, All
Cin;uifs and Two Inspacbon Trips Each Dwelling Unit @$80
total fee is $201 I 7/.
I�ed the electrical hslaVatlon desamed herein an the dates s�ed:
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��� Rough-in I�repection Required9 ❑ Yes ❑ No InspecUon Other Than Rough-In: 0 Ready Now O W�11 CaA
You muat call tha inspedor when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY �(J OWNER and hereby request inspection of the el�trical work at
Job Site Street Address City
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oMract/a^r or
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Please Provide Two (2) Phone Idumbers Im
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Master Elechician or Pawer
License Number
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