P - 76135ry REQUEST FOR ELECTRICAL INSPECTION � U
��� 2�� L� 2 � Minnesota Board of Electricity
1821 University Avenue Sufte S-128, Saint Paul, Minnesota 551U4
(651) 642-OS00 TTY/MRS 1-800-627-3529 www.edectricity.stnte.mn.us
De.scribe -using the back of the white copy if necessary - the urork covered by this uest:I
� 1 � �`� � �(+ I f � E� 't� eki E.r � o � D'� � o v S�
` GENERAL FEES Outdoor Li hting Standard @$1
SERVICES i POYtl�R SUPPLIES Traffic Sianal Standard f�a $5
,UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
$50 Per Unit
un,t LOi g25
CeMer
_ THIS INSTALLATION MAY BE ORDERED
I I�II II �I II I�I I� I� I) �I u�) � III � III �W I�
18202523
Transformers over 10 KVA $ 2tl
TransFormer 1 Pawer Supply for Sig� I Outlirre Liahting $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNR
Inciudes the Service and/or Power Supply up to 500 Amperag, All
Circuits and Two Inspection Trips Each DweAing Unit aQ �0
i
TOTALFEE •� � ��
total fee is $20) �� , p ,� ,�
THIS AREA FOR LYSKCi�t USE OARY tl �
• �i� S� V"o'
i fhe dectriwl inslallatlan desa�d herein on ihe d� s�ted: i
COMPLETED WITF
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"""'' Rough-In Inspectlon R uired? ❑Yes ❑No Ins
� 1,��� eq pedion Other Than Rough-In: ❑ Ready Now ❑ W�71 CaA
You must call the irrepector wrhen ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY �WNER and hareby reque.st inspection of the electrical work at
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. Elec6ical UWtyAddress
master t�eartc�an or
Ucense Number
or Owner
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OF YELLOW COW Y�`� BOARD OF ELECTRICITV COPV
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