P - 77406REQUES� FOR-ELECTRICAL INSPECTION ���'�°f'�,
1� Q O��,� � Z� � Minnesota Board of Electricity O�Q[j,�-� �
v 1821 University Avenue Suite S-128, Saint Paui, Minneso���04 �� '�,�
�� �
(651) 642-0800 TTY/MRS 1-$00-627-3529 www.eleczricity.state.mn.us ��,�,�
Describe -using the back of the white copy if necessary - the work covered by this request:
'' 2 � -Z. ��,��
GENERAL FEES Outdoor Li hting Standard $1
SERVICES I POWER SUPPLIES Traffic Siqnal Standard (� $5
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL
Lighting Retrofit @ $.25 per Fi�ure
Center Pivot Irriqation Boom (� $40
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outiine Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Inciudes the Senice and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
( Additional Ins ction Tri s $20 v—
Investigative Fee
Reins ction Fee $20
TOTALFEE
(minimum total fee is $20) a�
THIS AREA FOR INSPECTOR USE ONLY
t
I hereby ceAify fhat I inspected Ne electncal installation descnbed herein on the dates slated:
Roucr+in on.E
����'—~—�— ' o _ e �
FIN4L�NSVECTi01J � � ` DAIE —
Sp2C121 IfiSP2CtI0f1 $3� �f HOUf ExaiaEOrnenNOOnEO �i ��� oA�
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
�---------------------------------------------,-------------------------------------------
, � _-
I � C•. -�
I iill II III II III II III II Ill II II, II �il Il li( b� I I!�
18079798
°` Rough-in Inspection Required? �Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now�Will Call
lP d l �� You must cali the inspector when ready! Date Ready:
I ceRify that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at