P - 76157REQUEST FOR ELECTRICAL INSPECTION ��°�
° 0 6�� 7 3 6� Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electwicity.state.mn.res �� '�
:rib� g th ck of the whtte copy'rf nacessary - the work cover� by this request:
S(�� r%1 ° 6 O J
GENERAL FEES Outdoor Lighting Standard @$1
VICES / POWER SUPPLIES Traffic Sianal Standard (�D $5
401 to 800
Above 800
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Apparatus @ $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units
Transformer / Power Su I for Si / Outlirre Li htin $5
NE & NVO FAMILY DWELLINGS, EACH UNR
Includas the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ir�s 'an Tri $20
Inv�gative Fee
Reins 'on Fee $20
TOTALFEE
(minimum total fee is $ZO)
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I hereby certHy that I Nspeaed fhe alectricel installedon tleacribed herein on the dates afefed:
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I certify that I am the
Job Site Street Addrea
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COMfRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
City
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Secdon Renge Fire No. Co
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Anoka, MN 55304
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Please Provide Two (2) Phone Numbeis Incl
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Utility Address
: Con6ac6or Ucense Number Master Electriclan or Pawa
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atlon) Please Provide Two (2) Phone Numbers Incli
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