P - 78855REQUEST FOR ELECTRICAL INSPECTION
1—���- 2 6 8� Minnesota Board of Electricity -
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7821 University Avenue Suite S-128, SaiM Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEW ❑ REMODEL ADDITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - the xrork covered by this request:
� ��-, � �
GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES /,) Traffic Si�nal Standard � SS
rMMUNIC;ATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
to 12 Units � $50 Per
ach Additionat Unit � ;
1 BOW�I
Park Lc
Hour
IIIII III�� IIIII �I��I IIIII �I I�� II III IIIII �� ��
14532683
� Transformers over 10 KVA �D $ 20
� Transformer I Pmwer SupD�Y �� Si�ns / Outline LighGnq $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Exh Dwelling Unit �$60
TOTAL FEE ��.� c,`
(minimum total fee is $20) rgj� J`t�
tws FREA Fpi INSPECTOR USE pir
I hereby certiy that I inspecOed the ekctical insfalla6on described herein on the dafes sf�ed:
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I cefify that I am ttie � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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