P - 77658REQUEST FOR ELECTRICAL INSPECTION T"�y'eu�
I - Minnesota Board of Electricity ��S Qa�%�j� ��a ��
1�� 8 7� 6 O 8 � 1821 University Avenue Suite S-128, Sai�TP�uI'Minnesota 55104 �.�,-�� �. '
(651)642-0800TTY/MRS 1-800-6273529 wwx�.e[ectricity.state.mn.us "��t�
Describe -using the back of the white copy if necessary - the work covered by this request:
.. �22�. �, fC' i �tG14"�
0 to 400
ALARM, COMMUNICRT+6Pi-fiEfolQfE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units C� $50 Per Unit
Center Pivot Irrigation Boom
Manufactured Home Park Lc
Traffc Sipnal Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Tri s $20
Investi ative Fee
Reins ection Fee $20
TOTALFEE C'�
(minimum total fee is $20) ,.�`
THIS AREA FOR INSPECTpR USE ONLV
I hereby certrfy that I inspected the elecMcal installation described herein on the dates stated:
aWGH IN oATE
� 38-°S' �
In 5.31 Mile
TIMS IMSTALLATiON MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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18876086
uate: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: 0 Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I rtify hat I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
INSTRUCTIONS ON BACK OF YELLOW COPV eOARD OF ELECTRICI7V c:t]PV Fa_nnnn�n_�s n� �nne