P - 75998REQUEST FOR ELECTRICAL INSPECTION ��
�° o��� 411 � Minnesota Board of Electricity ,,,
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
`�� (651) 642-0800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
D�scribe -ush�g thp tiack of e white copy ff necessary - the work covered by this request:
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GENERAL FEES Outdoor Lighting Standard @$1
$ERVICES / POWER SUPPLIES Traffic Sianal Standard (a� �5
CIRCUITS OF LESS THAN 50 VOLTS
iystem bevice or Apparatus @ $.50
ADDITIONS TO THE GENERAL F
ILY DWELLINGS (PER UNIn
! Units @ $50 Per Unit
1ddiGanal Unft @ $25
OTHER ADDITIONAL FEES
9 Retrafit � $25 per Fodure
� Pivot Irtiaffiion Boom C�a $40
��I I II III II ill II II I II I II II �i II I� ��I �� I�
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Include.s the Service and/or Power Supply up to �0 Amperes, A�
Cirr.uits arM Two Inspecbon Trips Each Dwelling Unft @$BO
Add'�ional Inspection Trips @ $20
Invesdpative Fee
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total fee is $20) � �
I hereby c�erdfy U�at I hrepected tlre electrical InataVaBon des�xibed hereln an 9re dates sf�d: I
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"""'' Rough-in Inspectlon Requtred? ❑ Yea �No Inspectlon Other Then Rough-In: �dy Now 0 Will Call
��� � 6 You must call the inspector when readyl Date Ready. �� �
I certify that I am the�CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspe�ion of the electricel work at
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1804 Freeman Pt Rd Cromwell MN 55726 ^I
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Pherre Numbers I
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License Number
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ON BACK OF YELLOW COPY s�4RD OF ELECTRICI'fV COPV Fa.nnrm�e_�s a��rme