P - 76544REQUEST FOR ELECTRI AL SPECTION
1 r J��-� 5 5�3 Minnesota Board of Electricity ����o�Q -
1821 University Avenue Suite 5-128, Saint Paul, Minneso�5104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL 0 ADDITION REPAIR Describe -using the back of the white copy if necessary - the xrork covered by this request:
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ENE FE S_ Outdoor Lightinq Standard � E1
SERVICES I
ALARM, COMMUNICATION, REMOTE CONTROt
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Center Pivot
Mile
IIIII IIIII IIIII III�I IIIII I�III IIIII IIIII �� II�I
15808553
Traffic
0
_ 1 Transfortner / Power Supply for Signs / Outline Lightinq _$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE I �!, �
(minimum total fee is $20) � y�-
Twsna�FOaiNSVECTOa F
I hereby certiry that I inspected the elec6ical installa6on described herein on Ne dates stated:
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J �g / ��� DAT �+
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DAiE
OMPLETED WITHIN 12 MONTHS
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cyucsi uace: Rough-in Inspection Required? ❑ Yes ❑ No Inspedion Other Than Rough-In: ❑Ready No Will Call
�p �y� �� � You must call the inspector when ready! Date Ready
I certiry that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
Job Site Address (Street, Box, or Route No.) Citv �:., r..,�e
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BOARD OF ELECTRICITY COPV
niaster t�ecmuan a
License Number
EB-00001A-14