P - 77687c(�Q REQUE�,T FO�ELECTRI�AL INSPECTION
1� V J.J - 9 7 5�7 Minnesota Board of ElecUicity �;(�� -(j,,2��/ �
1821 University Avenue Suite S-128, Sairrt Paul, Minneso �'I �4
��(,� '� � (651)642-0800TfY/MRS 1-800�27-3529 www.e[ectricity.state.mn.us
❑ NEW ❑ REMODEL ❑ ADDITI N REPAIR Describe -using the back M the white copy if necessary - the work covered by this request:
GENERAL FE Outdoor Liqhtinq Standard C1a 81
JICES / POWER SUPPLIES
0 to 400 Ampere @ $25
401 to 800 Amoere � E50
D to 200 Am re $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SI6NALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus $.50
ADDITIONS TO THE GENERAL FEES
2 Units @ $50 Per Unit
Additional Unit @ $25
iER ADDITIONAL FEES
25 per Fixture
i Boom @ $40
Park Lots � $25
Park Sites � S5
IIII IIIII IIIII IIIII IIIII I�III III�� II��I �� I�
16999757
Traffic
� Transformer / Power Supply for Siqns I Outline Lightinq $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Paxer Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit @$80
Fee
(minimum total fee is $20) � �.�
iH15 MEA FOR INSPECTOP USE pdV
I hereby ceAiry that I inspected the ekwtrical installa6on described herein on the dates siated:
-'�/,-2
Kequest_�a�e: Rough-in Inspection Required? ❑ Yes No �r�.s
__ _ pedion Other Than Rough-In: ❑Ready Now ❑ Will Call
�.fSi Yau must call the inspectw when ready! Date Ready: �� �,�
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
GC-U{M)1A-19 C.1. "2W2