P - 77581REQUEST FOR ELECTRICP� INS�ECTIQ N_ r
�� J��- 3 2 4� Minnesota Board of Electriciry �CQDS '�/p�s. -
`r 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OB00 TfY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ ADDITION A` REPAIR Describe -using the back of the white copy if n�essazy - the work covered by this request:
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b� �L ts i, c�, !�n i� s� r—
GENERAL FEES Outdoor Lighting Standard �$1
'LIES ,e� Traffic Sanal SNandard � SS
IMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
TO THE GENERAL FEES
3 to 12 Units @ S50 Per Unit
Exh Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Rehofit @ $.25 per Fixture
Center Pivot Irtiqation Boom C� S40
INST
IIIIIIIIIiIIIIIIIIIlIIIIIIlIIIIIIIIIIIIIp�I��
15173248
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 � 580
TOTAL FEE -7 ��
(minimum total fee is $20) . ��
rHis naEn Fae ir�saEC,aa use aur
I he2by cerOry that I inspecMd the ekctrical installa6on described herein on the dates stated:
12 M
2 a-e j I
Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑Ready Now ❑ Will Call
You must call the inspecta when ready! Date Ready:
IN87RUG710N8 ON BACK
BOARD OF ELECTRICITV COPY
EB-OODOtA-14 8.7.2002