P - 75453� REQUEST FOR ELECTRICAL INSPECTION
1 s� ��� 2 6 5 0 Minnesota Board of Eleotricity
1821 University Avenue Suita S-128, Saint Paul, Minnesota 55104
(651)642-OSOOTTY/MRS 1-800-627-3529 www.eleciricity.sdate.mn.us
D�ribe -using the back of the white copy'rf ne�essary - the work cover� by this requ�t: �
i�%�A LL U/�d%�i'�LAt3'a CL. L�G j�% C fi�T/A/�
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traftic Signal Standard @$5
Transfortners u to 10 KNA $10
Transfortners over 10 KVA @$ 20
Transformer I Pouver Supply for Sigr�s / Outline Lighting @$:
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Inctudes the Service andlm Power Supply up to 500 Am�res, AII
Cirtarit5 and Two Iruspecction Trips Each Dwelling Unit @$E
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Ap�s @$.50
ADDRIONS TO THE GENERAL FEES
fIFAMILY DWELLINGS PER UNIT I V IAL hEt /`
3 to 12 Units @$50 Per Unit (minimum total fee i� $20) �i.sV
Each Add'IUonal Unl� @ $25 �"`�"`°" "6"�c'°"`�`"aY
NOU o72� °
OTHERADDITIONALfEES �� � �v���-i
Lfghtin Retrofit @$25 pBr Fhdu�e I hereby c�tl1y that I in.speded fhe et�xl irefallaTio�Td� herein orttt(e dafes sta�d:
Cerder Pivot I' ation Boom @$40 R01°' °' � °ATE
Maniifar.fiimd Hema Park L�tc G31 �'J5 - '� � K�ir�f �'� � c
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� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF
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F�OR OFFIGE USE OEdLY
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�� Rough-in Inspectlon Requhed7 ❑ Yes ❑ No Irrspedian Other Than Rough-In: ❑ Ready Now � WiU Call
��% L� � You must call the inspector when readyl Date Ready:
I cerbfy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY � OWNER a� hereby r�uest inspection of the electrical work at
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Please Provlde Two (2) Phorre Numbers Includh�g Area
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LJcerree Number
or