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P - 75753� REQUEST FOR ELECTRIC L INSPECTION ' 1�� 3�—� 4 4� Minnesota Board of Electricity p�Q�j�rQa�B� 1821 University Avenue Suite S-128, Saint Pau , Minnesota 55104 (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �'' "� ��, � the w� co�PY�! ��iCi, �ered by th� uest:� � GENERAL FEES Outdoor Li hting Standard @$1 � / POWER SUPPLIES iM, COMMUNICATION, REMOTE CONTROL, ;UITS, CIRCUITS OF LESS THAN 50 VOLTS Each SvsDem Devtce or Aooaratus C� $.50 Add'rfional Unit @ Center Pivot Traffic Signal Standard (a� $5 Sup lemental Fee � $20 Transfortners u to 10 KVA $10 Transformers over 10 KVA $ 20 Transfortner / Power S I for Si ns / OuUme Li hti $5 ONE & 1W0 FAMILY DWEWNGS, EACH UNIT Includes the Service ami/or Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dweping Unit @$80 Fe� � $20 TOTALPEE iimum total fee is $20) �� i I hereby certfytlret I ins�ded tlre etecttical inatallatlan desa@ed herein on the dates sfated: � Gn Ins on $20 �-^�'Q'" �°' tlon @ $30 r Hour °�D/ Hon � $.31 per Mile ATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIId 12 �ora c�rFice use ctr.a�v III�IIIIIIII�I�IuIII��ululll�lu��l� 18341446 """'' /� Rough-in Inspecdon Requlred7 ❑ Yes �No Insp�tion Other Then Rough-In: ❑ Ready Plow ❑NM CeU ��SO�d s�` You must call the inspedor when readyl Da[e Ready: I certify that I am the ENSED CONTRACTOR ❑ COMPANY ❑ DWPIER and hereby request inspection of the electrical work at J� Sfte Street Ad Cgy �� .3 f�� r`�1��, � :e._.l ( ----_ om��Nmt�e�� ` ss (Contrador ompany or Owner Perform liu �S e �, ontrador or Owner nrdffSTnstell� �, �ato Lloe�e Ninn6er � ��C��i ��