P - 78038[ REQUEST FOR ELECTRICAL INSPECTION
1� J��- 218 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
EW ❑ REMOD ❑ ADDITION ❑ REPAIR Describe -using the `k� of ihe white copy 'rf necessary - the work covered by this request:
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6ENERAL FEES Outdoor Li h6n Standard $i
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Amcere @ E25 Suoolertiental Fee C� $2(1
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @ 550 Per Unit
Each Additional Unit � $25
Lighting Retrofit � $.25 per Fixture
Center Pivot Irriaation Boom � S4(
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Includes fhe Service andlw Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
( TOTAL FE; I (� /`'�^ �
minimum total fee is $20 �L l/
THIS MFA FOR IlSPECiOR 11SE
I hereby certify that I inspecled the el�,tic� installaAOn described herein on tlie dates stated:
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Req Date: Roughin Inspection Required? ❑ Yes f9TJo Insper,tion Other Than Rcwgh-In: ❑Ready Now ONPiII Call
i must call the inspector when ready! Date Ready.
I certify that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricai work at: