P - 78197REQUEST FOR ELECTRICAL INSPECTION
i� 5 8[t � 0 6 7 � Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-08Q0 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW 0 REMODEL ❑ ADDITION O REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
�u�nace -+ � �, `d� �e�- �eh�K-- ��
GENERAL FEES Outdoor Liqhtinq Standard �$1
SERVICES /
200 Ampere (�$10
)MMUNICATION, REMOTE CONTROI
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Aooaratus (�a 5.50
3 to 12 Units
Each Additio
Lighting Retrofit
Center Pivot Irri�
Hour
II� II �I il lU II IEI II lil ll �ll II III II III a� I
1 5 8 4 0 6 7 1
Traffic
10 KVA
� Transfortner / Power Supply for Signs / OuUine Liqh6ng $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Reins tion Fee $20
TOTALFEE C
(minimum total fee is $20) �• J�
iH15 AREA FOR INSPECTOR USE IX1Y
I hereby certify that I inspected ttie electrical installa6on described herein on the dates sfated:
NOT
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rteques uate: Rough-in Inspection Required? L�Yes LJ No Inspection Other Than Rough-In: �Ready Now� Will Call
� f,/(��� Yau must call the inspector when ready! Date Ready:
I certify that I am ihe '� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at::
INSTRUCTONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPV EB-00001M74 8.1. 2002