P - 77157REQUEST FOR ELECTRIC L��� CTION �-
1� 9 2� 8 6 6� Minnesota Board of Electricity v�
1821 University Avenue Suite S-128, Saint Paul, Minneso�4 �:
3�j�' (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Out oor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic Sianal Standard Ca� $5
IALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aaoaratus a(� $.50
Each Additional Unil @
Lighting Retrofit @ $25 per Fixture
Center Pivot Irriaation Boom l�D $4(
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED
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Transformers over 10 KVA $ 20
Transformer I Power Supply for Signs I Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Add'Rional Insoection Trios l� $20
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total fee is $20) c�� . �
that I inspeded the electrical installafion desaibed herein on the dates stated:
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uaLe: � Rough-in Inspection Required? ❑Yes �JO Inspection Other Than Rough-In: ❑ Ready Now �Will Call
`, ���� Yau must call the inspector when ready! Date Ready:
I cedify that I am the �CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address City
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Township Section Range Fire No. County
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Owner/Occupant Name Please Provide Two (2) Phone Numbers InGuding Area Code
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Electrical UGIR Electriral UGlity Address
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Contractor / Company Name � C
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��"1 License Number
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Please Provide Tw (2) Phone Numbers Including
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