P - 78226/�c REQUEST FOR ELECTRICAL INSPECTION
1'�F G�- 5 9 0�0 Minnesota Board of Electriaty
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state,
❑ NEW EMODEL ❑ ADDITION 0 REPAIR Describe -using the back of the white copy if necessary - the work cov
Rw� F�R SH� ��v �i�c� ��A C2J Rds T v�r��tr )(�T
GENERAL FEES Outdoor Lighting Standard $1
SERVICES / POWER SUPPLIES Traific Sianal Standard �? $5
iu nm re W ' ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
200 Am re$10 Includes lhe Service andlor Power Supply up to 500 Amperes, All
IMMUNICATION, REMOTE CONTROL, SIGNALING Cirouits and Two Inspection Trips Each Dweliing Unit @ E60
CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri $20
i stem Device or alus E.50 Inves6 ative Fee
ADDITIONS TO THE GENERAL FEES Reinsoection Fee � S2(1
3 to 12 Units @ E50 Per Unit
Each Additional Unil @ E25
OTHER ADDITIO
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irtia�on Boom � S4(
TOTAL FEE / 4' � —
(minimum total fee is $20)
THIS AREA Fqt INSPECipt USE ONLY
I c�fy that I inspec�d the elechical i da�pibed herein on the dafes st�ed:
FEES ��� ��� p?�jvS�S
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�� @: Rough�n Inspection Required7 }dYes ❑ No Inspedion Other Than RougMn: ❑Ready N� I Call
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�� �� You must call the inspeda when readyl pate Rp,ady.
I certiTy that I am 1he�CENSED CONTRACTOR 0 COA�ANY ❑ OWNER and hereby request inspection of the electrical work at: