P - 79926� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-184 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529
www. e%ctricity.state.mn. us
Identity the work covered by this request:
L7REW ❑ REMODEL ❑ ADDITION ❑ REPAIR
Above
G
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus (� $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNIT
3 to 12 Units �$50 Per Unit
Lighting Retrofit
Center Pivot Irm
XC.EL Eh1EROY SAVER'S SWiTGH
Outdoor LioMino Standard � $1
Trar�sformers u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transformers / Power Supply for Signs / OuUine Lighting �$!
ONE 8 TWO FpMILY 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 Insoection Trios � $20
USE ONLY
ROUGH IN
FINAL INSPECTION
I inspectetl ihe
AL
DATE
DATE
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FOR OFFlCE USE ONLY
I Iillll IIIN lilll IIIiI INII �II IIIII IIIII {� Ini
* 1 3961 842* �� °��
Reque���2 Rough-in Inspectlon Required? ❑ Yes C�No Inspection Other Than Rough-in: �Ready Now ❑�II Call
You must call the inspector when ready! Date Ready:
I certify that I am the �4 LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at:
Job Address,(wtrgflt, Bo�_qq�t� No l � City ��Y Zip Code �
l3iiil MK) It�i
Seciion Township Range Fire No. County A��A
h
occupRAHN CARROL C Pnone
Power Supplier Address
�L �Y
ElectricaH oU� o� m4an�Gam�e ����� Contractor Lice�ns�e N�$� ' Master License Number
C1R
►�na�r� � ��'(�1�.`ry��r�Pb%11(�Psta�onMN 55114
Authoriz ' nature (�rector, mpany or Owner Perfortning Installation) Phone
651 8,6-2�11
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY