P - 77059(� REQUEST FOR ELECTRIC,�L INSPECTION
1��.4J�� - 5 9 8� Minnesota Board of Electricity ,� �S �o�(p �p /
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' (651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW 0 REMODEL ❑ ADDITION EPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
�-. , ._ _ .
SERVICES / POWER SUPPLIES
Trmsiortners uu to 10
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am e$10 Includes ihe Service andlor Power Supply up to 500 Amperes, All
2M, COMMUNICATION, REMOTE CONTROL, SIGNALING Grouils and Two Inspection Trips Each Dwelling Unft @ E60
;UITS, CIRCUITS OF LESS THAN 50 VOLTS Additio� Ins ' n Tri L20
Each S stem Device a ratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins tion Fce E20
iIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units @ S50 Per unit (minimum total fee is $20)
E2ChAdditiOnelUnit@$25 *wsu�nFOnins�cTOaus r �
1 hereby cerUfy that I inspec�d the ekctric� insialla6on described herein on the daAes staBed:
OTHER ADDITIONAL FEES � �
Li h6n Retrofit $.25 r Fixture
Center Pivot Irtipation Boom �D yl0 "�' w �,rE
Mile
IF
(Ilil IIIII Illii IIIII IIIII IIIII lilll IIIiI N� I�
17015983
Request e: Rough-in �nspection Required4 ❑ Yes ❑ No I�upectan Other Than Rough-In: ❑Ready Now ❑ VVill Call
'� ��, O� You must wll the inspeclawhen ready! Date Ready: _
I certify ihat I am the "'�ICENSED CONTRACTOR 0 COIu�ANY ❑ ONMER and hereby request inspection of tlie electrical work ak: