P - 75313REQUEST FOR ELECTRICAL INSPECTION � ,..
2° o�7 2� 7 4 3� Minnesota Board of Electricity
C� � 1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104
(651) 642-0800 TlY/MRS 1-800-627-3529 www.electricity.state.mn.res
'be -using the the white copy'rf necessary - the work cwered by this r�uest:
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GENE FEES Outdoor Lighting Standard @$1
SERVICES / POWER SU„�FS Traffic Siqnal Startdard an. $5
200 Am re$1Q "� Includ� the Service andlor Power Supply up W 500 Amperes, All
IMMUNICATION, REMOTE CONTROL, SIGNALING Cira�ts and Two Irrspection Trips Each Dwelling Unit @$BO
CIRCUITS OF LESS 1'HAN 50 VOLTS Add(tional Ins on Tri s$20
i m bevice or Apparatus @$.50 Investlgative Fee
ADDITIONS TO THE GENERAL FEES Reins on Fee $20
LY DWELLINGS PER UN TOTAL FEE
Units @$5o Per unit (minimum total fee is $20)
�dditional Unft@ $25 T�^�^�����
OTHER ADDffIONAL FEES
Retroffi @$.25 � FixtUte I hereby ceNfy that I i�ected the ele�trlcal I�taVatlon descr@ed herein on fhe datea �Oed:
Pivot Irtigation Boom @ $40 �" �' ��
�ctured Home Park Lots $25
fional Vehlcla Park Sit� $5 �°is"�"0N m+T�
de Bond' Ins 'on $20 '�1 �` �
�ction @ $.31 per Mile �
LLATION_ MAY BE ORDERED
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�OR OFFICE U:iE'
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�y I�� � Rough-in Inspectlon Required7 ❑ Yes �No InspecUon OUrer Than Rough-In: � Ready Now � Cell
( � You must cell the inspedor when readyl Date Ready:
I certify that I am the �1.ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection af the electrical work at
Job Site Street Addr�s Cny 1
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Please Provide Two (2) Phorre Numbers Includir
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i�� Master Electrician or Power Li
Licer�se Number
Please Provide Two (2) Phone Numbers Includin
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