P - 772557 REQUEST FOR ELECTRICAL INSPECTION
1� 1 O�- 0 4 9� Minnesota Board of Electricity
1821 University AvenU� Suite S-128, Sai� Pa�, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
0 NEW MODEL_ O gDDITION ❑ REPAIR Desaibe -using the back ot the white copy if necessary - the work covered by this request:
GENERALFEES
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS PER UNI'
3 to 12 Units @ 550 Per Unit
Each Addition� Unfl @ E25
OTHER ADDITIa
' htin Retrofit 5.25 Fixtu2
Center Pivot Irtiaation Boom @ S4(
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IIII II III II lii I I II I II III I I III II I II I� I II a� I�
17060492
Tralf� Si nal Standard S5
Su lement� Fee $2(1
Transfamers u to 10 KVA S10
Transfortners over 10 KVA E 20
Transfortner I Power Su fa S' ns I Outline L' h6n $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Exh Dwelling Unit @ S80
(minimum botal fee is $20) �7 �j
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I hereby certy tliat I i�d the dec9ical insfall�on desaibed herein on the da�s staEed:
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:� Roughin Insper.iion Required? O Yes l�b Inspedion Other Than RougMn: �y Now ❑ VYW Call
You must call Me inspeda whe� ready! Dete Reedy. .
I certiiy i am ttie ICENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request iispecfion of the elecbical work at:
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EB-0OOD1A-19 .1. 2002