P - 77047REQUEST FOR ELECTRI���AISP��� ���'�
1 _ � � � _ � � � � Minnesota Board of Electricity p� 1'C.b� �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 104 �.
(651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �`���
Describe -using lhe back of the white copy if necessary - the work covered by this request:
'� . �.� a � �. \ ..r� L . � -. ,.��/"�s i r
I SERVICES / POWER SUPPLIES
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus C� $.50
Each Additional Unit @
Lighiing Retrofit @ $.25 per Fixture
Center Pivot Irriaation Boom na $4(
Traffic Signal Standard
Supplemental Fee @ $
Transformers uo to 10'
ONE R TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up l0 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investigative Fee
Reinspection Fee $20
TOTALFEE -�—�
(minimum total fee is $20) ���,�L'� ��j ��
THIS AREA FOR INSPECTOR USE ONLY
I hereby certiry that I inspected the electrical installalion descnbed herein on the dates stated:
-��J
Special Inspection $.31 er Mile
THIS INSTALLATION MAY BE ORDE
DISCONNECTED IF NOT COMPLETED WITHIN 12
t
ii�� �� ��� e� (�� �� �� �� ��� �� ��� �� ��� �� ��� �� ��
13858951:
Date: Rough-in Inspection Required? ❑ Yes �Jo Inspection Other Than Rough-In: ❑ Ready Now�ill Call
�� I t e��� You must call the inspector when ready! Date Ready:
I certify that I am the� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: