P - 75742REQUEST FOR ELECTRICAL INSPECTION �' �t
1� 9 210 �� 0 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.vs
De.scribe -using the back of the white - e covered by this�est�.� /-/,"` ��� �
GENERAL FEES Outdoor Liahtina Stand $1
0 to 200 Am�re @ $5
Above 200 Ampere @$10
tM, COMMUNICATION, REMOTE CONTROL, SIG
;UITS, CIRCUffS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units an. $50 Per Unit
i Home Park Lots
Vehicle Park Sft�
THIS INSTALLATION MAY BE ORDERED
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19212208
Fee
Includes the Service and/or Power Supply up to 500 Amperas, All
Circuits and Two Inspedion Trips Each DweUmg Unit @$BO
Addfional Inspection Trips @ $20
Imestlgative Fee
total fee is
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I h�speded the etechrical 6ista0aHon desrnbed herem on tlre dat� s�ted:
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You must call the inapector when ieadyl Date Ready.
I certify that I am the ❑ LICENSED GONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ai
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Please vro (2) Phone N bers I
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� fJum� Master Electrician or P
` � Licerise N�nnber
Please Pravide T 2 Pho N I
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