P - 81992REQU�ST FOR ELECTRICAL INSPECTION
�:.
1 13 3 19 4� Minnesota Board of Electricity -
� r 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
` x�w�w. electricity.state.mn. us ' �'
Identify the work covered by this request:
�I NEW ❑ REMODEL ❑ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$t
SERVICES / POWER SUPPLIES Traffic Sianai Standard �$5
Above 800 Ampere
�UITS / FEEDERS
U to 200 Amoere �
:UITS, CIRCUITS OF LESS THAN 50 VQLTS
Each Svstem Device or Aooaratus �$.50
OTHER ADDITIONAL FEES
Recreationai Vehicle Park Sites �
� $.31 pet Mile
Transformers over 10 KVA � $20
Transformer / Power Supply for Signs ! Outline Ughting �$5
ONE & S1N0 FAM{LY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliin Unit �$8(
Additional Inspection Trips � $20
Investiaative Fee
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FOR OFF�E USE ONLY
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* 1 1 3 3 1 9 4 9�F
total fee is
5.50 f
ed Uie elechical instella� des�xibed herein on the dates s�ted:
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-7-2�-01
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I certify that I am the [� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecction of the electrical work at:
Job Address (Street, Box, or Route No.) Citv ZiD Code
Sec[ion Township f
`
Occupant �
BZ'1C�{Tl@Z' BUl1C�i2Y'S �'�
Power Supplier �
Xce1 Energy
Electri�al Contredor / Comparry Name
La.zer Electric, Inc.
Mailing Address (Contta r, Company or Owner Pe�
8164 'Street NE.,
Authorized Signatu (C tractor, Compan ne
EB-0OOOtA-13 7
Phone
CA01110
istaNation)
Lng Lake Park, MN 55432
ing Installation) Phone
� 763-784-3729
BOMD OF ELECTRICITY COPY IN5rRUCIlON3 ON BACK OF YELLOW COPY