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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 EC'P. �}�FlCE !JSE �NL� p��� � � � � . ) �� F9 ��t I �— L�GC """'' 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 Job Si[e � ir�s �� � '� � � r' � lV o J� Township SecUon Range Fire No. CouMy ,A-v►�kc�- �, Ca� �� I� � I-{ �a s (�ri�) s��_� . Elec6ical UWtyAddress master t�eartc�an or Ucense Number or Owner � � �7sIf4 I \ � OF YELLOW COW Y�`� BOARD OF ELECTRICITV COPV / -��s