P - 782181-493-005 �
❑NEW EMODEL OADDITIQN ❑ I
SERVICES I
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 T1Y/MRS 1-800-627-3529 www.electricity.state.mn.us
R Describe -using the back of tf�p�white copy 'rf necessary - Ne wak covered by this request:
iM, COMMUNICATION, REMOTE CONTROL, SIGNALING
,UITS, CIRCUITS OF LESS THAN 50 VOLTS
Exh System Device or Apparatus @ S.SD
ADDITIONS TO THE GENERAL FEES
fIFAMILY DWELLINGS PER UNI
3 to 12 Units @ E50 Per Unit
Each Additional Unfl � 825
OTHER
Ligh6ng Retrofit � $25 p
Center Pivot Irriaation Ba
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1Y BE ORDERED DISCONNI
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14930051
Trafic Signal Standard
Suoolemental Fee O 8
ONE � TWO FAMILY DWELLINGS, EACH UNIT
Indudes the Service and/or Power Supply up to 500 Amperes, All
Circuifs and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE I � o
(minimum total fee is $20) � i
iH15 ARFA FOR INSF£CT00. USE Oflv
I hereby cerUry U� I i the ek�ctrical insfala6on desaibed herein on the d�es staEed:
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KeQues[ ua�e: Roughin Inspection Required? � Yes ❑ No Inspection Other Than Rough-In: ❑Ready Nav � Will Call
� p� + 3 � � 3 You must call the inspecta when ready! Date Ready. _
I certi(y that i am 1he�UCENSED CONTRACTOR ❑ CONPANY ❑ OWNER and hereby req�st inspection of the electrical work at: