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JICES I POWER SUPPLIES
0 to 400 Amcere C� $25
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REQUEST FOR ELECTRICAL INSPECTION -
Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-800-627-3529 www.electricity.state.mn.us
EPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
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Outdoor Li hUn Standard $1
Traffic Sianal Standard O 85
CIRCUITS I FEEDERS ,�-
0 to 200 Ampere @ $5 � /p,//(�
' Above 200 Ampere �$10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
to 12 Units �$50 Per Unit
ach Addi6onal Unit @ $25
OTHER ADDITI01
gh6ng Rehofit � $.25 per Fi�Aure
enter Pivot Irri�ation Boom � $4(
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTALFEE �
(minimum total fee is $20) � �
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I hereby certify that I inspected the electrical installalbn desaibed haein on Ihe da6es staBed:
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Request Dffie: Rough�n Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑Ready Na+� Will Call
�o�� d,� You must call the inspector when ready! Date Ready.
I certify that I am the �^^LICENSED CONTRACTOR OCON�ANY ❑ OWNER and hereby request inspecction of ihe electrical work at: