P - 76365REQUEST FOR ELECTRICAL INSPECTION `�
2°�J 4 � O� 1 � Minnesota Board of Electricity �s �
� � � 1821 Universit y Avenue Suite S-128, Saint Paul, Minnesota 55104
C�[��' (651)642-0800TTY/MRS1-800-627-3529 www.electricity.state.mn.us ���
Describe -using the ck of the white copy 'rf necessary - the work covered by this request:
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_ GENERAL FEES Outdoor Liahtina Standard C� $t
0 to 400 Ar
401 to 800
Above 800
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aoaaratus na $.50
Each Additional Unit @
OTHER ADDITIONAL FEES
Li�hting Retrofit @ $25 per Fi#ure
Center Pivot Irriaation Boom � $40
Ho��
Fee
over
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investi ative Fee
Reins ction Fee $20
TOTAL FEE �
(minimum total fee is $20) �i �
iHIS ARFA FOR INSPECTOR USE ONLY
I hereby certify that I inspeded the elecVical installation described herein on the dates stated:
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IIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Date: Rou h-in Ins ection R uired? ❑Yes No Ins
�_ O� g p eq pection Other Than Rough-In: ❑ Ready Now Will Call
� You must call the inspector when ready! Date Ready:
I certify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at