P - 75992REQUEST FOR ELECTRICAL INSPECTION �
; � � � � � � � � � � Minnesota Board of Elecficity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-$00-627-3529 www.edectricity.state:mn.us
De.scn'be ' e back of t#"s white nec�ssary„ the +mork covered by this requ�t:
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GENERAL FEES Outdoor Lightin Standard (a� $1
SERVICES / POWER SUPPLIES , Traific Sianal Sfandard C� $5
IICATION, REMOTE CONTROL,
ITS OF LESS THAN 50 VOLTS
Device or Aonaratus (d! $.50
1 THIS IIVSTALLATION MAY BE ORDERED D
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18356659
Transfomrers to 10 KVA $10
Transformers over 10 KVA @$ 20
Transfortner / Power Supply for Sigr�s / OuUine Lighbng @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, A�
Circuits and Two Inspection Trips Each DwelGng Unit @$80
TOTAL FEE
total fee is $201
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I hereby certHy tliat I tlre ele�ical Ns1allatlan desafhed herein on tl�e dates s�ted:
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IECTED IF NOT COMPLETED WITHIN 12 MONTHS
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" JP��� /q Rough-in Inspectlon R�uired7 � Yes ❑ No Inspection Other Than Rough-In: 0 Ready N Wi0 CaU
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�c� ci You must cell the Inspedor when readyl Date Ready.
I certify that I am the UCENSED CONTRACTOR O COMPANY ❑ OWNER and hereby request inspectiun of the electrical work at
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BOARD O ECTRICITV COPV
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Master FJectridan or Power Limited l
Licsnse Numt�r
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FR_(M1f11NA_15 N1'IM1d