P - 75817REQUEST FOR ELECTRICAL INSPECTION � �
s,
1��-� �� 9 6 3 � Minnesota Board of Electriciry ;� �:
1821 University Avenue Suite 5128, Saint Pau4 Minrre.sota 55104 �. - :
(651)642-0800TT1f/MR -8 -3529 www.edectricity.state.mvr.us ` "�� �
Desctil� -us' the , of the ite copy'rf neCessery - the work cov by this 2qu .
vca�,c � c- .
E ERAL FEES Out r Lighting Standard @$1
SERVICES / POWER SUP S Tra(fic Sianal Standard C� $5
:URS/FEEDERS
�to 200 Ampere @ $5 .¢ .e
Above 200 Ampere @$10
tM, COMMUNICATION, REMOTE CONTROL
;URS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unft
:pection @ $30 per Hour
:pection @ $.31 per M�e
ALLATION MAY BE ORDERED
�lul ulu ulu IIAI IIIII Ilu) �lu ulll �� I�
19339639
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over
Includes the Service andlor Power Supply up to 500 Amperes, A�
Circui� and Two Ir�spection Trips Each Darelling Unit @$80
Addi�onal Ir�s 'on Tri $20
Irnestigative Fee
Reins ' n Fee $20
TOTAL FEE
(minimum total fee is $20)
TFq9 AREA F�t PlSPECTOR IISE OMY
I hereby certify tlrat I G�d the etechical mstallallnn d� herein on tlre def� s�ted:
IF NOT COMPLETED WITF
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��� ough-in Inspecdon Requir�7 ❑Yes �{�/ Inspecdon Otherll
You must call the Inspec[or when ready! ` Date Ready.
I certify that I am th ENSED CONTRACTOR ❑ COMPAWY ❑ OWNER and hereby
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of the el�trical work at
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