P - 77645REQUEST FOR ELECTRIC IN ECTION ��
1��.�%� - 7 9 3� Minnesota Board of Electricity �(��� 1/ %�� �- :�
1821 University Avenue Suite S-128, Saint Paul, Minn€sofl�951'94 �``
� e� q� (651) 642-0800 TTY/MRS 1-500-627-3529 www.electricity.state.mn.us
Describe -usin the back of the ite copy if necessary - the work covered by this request:
C��SG � \ - �-1 '-1 •' � � S
GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic Siqnal Standard (� $5
' Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CANTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Each Additional Unfl @ $25
OTHER ADDITI01
Lighting Retrofit @ $25 per Fixture
Center Pivot Irriaation Boom an $4C
Special Inspection $30 per Hour
S ial Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED
IIII IIIII Iliii Il�li Ilill Illri IIIII IIIII ��I i��
18687939
j Transformer I Power Supply for Signs I Outline Lighting @$5
OtJE & TWO FAMILY DWELLINGS, EACH UNIT
fcludes the Service andlor Power Supply up to 500 Amperes, Ali
Circuits and Two Inspection Trips Each Dweiling Unit @$80
Additional inspection Trips @ $20
Investiqative Fee
TOTALFEE Q
total fee is $20) .�T) ��
I hereby certify that I inspeded the electrical inslallation described herein on the dates stated: �
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NPLETED WITHIN 12 MONTHS
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Rough-in Inspection Required? ❑Yes�No Inspedion OtherThan Rough-In: ❑ Ready Now �ill Call
�� `� �� 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 wo�1c at
Job Site Street Address CRy
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INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF EIECTRICITY COPY cw.nnnme_�s n� onnn