P - 78497REQUEST FOR ELECTRICAL INSPECTION -
1 � 01- 2 2 7❑1 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.state.mn.us
❑ NEW EMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy�jf necessary - the work covered by this request:
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SERVICESI
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ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
Center Pivot Irtigation Boom
Manufactured Home Park Lc
Recreational Vehicle Park S
S ecial Ins ecGon $.31 er Mile
THIS INSTALLATION MAY BE
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15012271
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Su lemental Fee $20 V
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns / Outtine Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips E�h Dwelling Unit �$80
TOTAL FEE I / � �
(minimum total fee is $20) �(�
THIS MFA FOR INSPECTqY USE plY
I hereby cer6ry that I inspecled the eleclrical inslallaUon described herein on the dates s�ted:
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rcequ � uaca: Rough-in Inspedion Required? k� YesF ❑ No Inspectiwi Other Than Rough-In: ❑Reatly Now �lill Call
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, � You must call the inspector wher�ready! �: Date Ready. .
I certify that I am tl�e ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tl�e electrical wak at: