P - 76226REQUEST FOR ELECTRICAL INSPECTION
���� ��� � 1821 Unrv rsity Aven e Su'��te S-128, Saint Paul, Minn�ota 55104
._ (fi51)642-0800T1Y/MRS 1-800-627-3529 www.electricity.state.mn.us ��"" "``
D�ail� -usir�g back of the white copy'rf n�s�e� - the work cover� by this request:
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o° r sw� t CS s �f '1' �+ f `,� i.� G�N'�►' w/Q. 'c�'kl+ta aQ:v,i� pe�o>w aac�,r�- � e eC � �'��'
GENERAL FEES Outdoor ' hUng Ste� @$1
SERVICES / PObVER SUPPLIES Traffic Sianal Standard no $5
401 to 800 Am re $50 Transfortners u to 10 KVA $10
Above 8D0 Am re$75 Transfortners over 10 KVA $ 20
:UITS / FEEDERS Transformer / Povrer S for�i J Outl'me LI $5 .
0 to 209 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Atmve 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
tM, COMMUNICRTION, REMOTE CONTROL, SIGNALING Circuits and #�an Trips -_ Each Dr�eUing Unit @$BO
;UITS, CIRCUITS OF LESS THAN 50 VOLTS Addrtional Ins 'on T $20
Each System Device or s$.50 Investigative Fee • -_ �
ADDITIONS TO THE GENERAL FEES Rei� on Fee $20
TIFAMILY DWEWNGS PER UN TOTAL FEE B�� r�
3 to 12 Units @$50 Per Unit (minlmum tOt21 fee lS $201 �J` J
� ReVOfit @$25 per FoQure I hereby ceAdy that I hm�ed Ne electriral I�tallaBon des�nbed herein on Bre detaa smted:
Pivot Irtfgation Boom $4U aarcx w ��un � z
s�ured Home Park Lots $25
donal Vehicle Park Sft�s $5 �TM"� �'�' � �_�y��
b n,.�a:�.. i..e.,e.a�.... � a•m _
S Ins on $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTEQ 1F NOT COMPLETED WITHIN 12 MOPITHS
FOR OF=lCE USE ONl'r
IIIIIIIIIIIIuI����I�u�IIIIII�I�O�I� ��� �AR 3 0 2001 .
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�� Rough-fn Inspedion Requhed? {�Yes ❑ No Inspecdon Otl�er Than Rough-In: ❑ Ready Now ❑ W01 Call
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You must call the inspector rahen ready! Da[e Ready.
I certify that I am the O UCENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at
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