P - 75765REQUEST FOR ELECTRIC L� 9I E I p� �'�'
Minnesota Board of Electricity o�V ��' �� (� ,
1���� - 4 7 5 � 1821 Un' ' Avenue Suite 5-128, Saint Paul, Minnesota 55104 �
(65%I�8 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Des� ba e white conv ff necessary - L ered bv this reau�st -+ �
Above 200 Am �ere a $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Unik @$50 Per Unit
FEES
Special Ins�ection @ $30 per Hour
Special Ins on @$.31 r Mile
THIS INSTALLATION MAY BE ORDERED [
Illll IIIII ul�l (II�I I��II (l�u IIIII �II) �� I�
18924753
Outdoor Lighting Standard @ $1
Tra�c Signal Standard @ $5
Sup lemenlal Fee @ $ZO
Transfomrers u to 10 KVA $10
� Transfortners over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE 8 TWO FAMILY DWEWNGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s a$ZO
Investiaative Fee
TOTAL FEE I � • ��
total fee is $20)
I hereby certHy that I i�pected the el�trlml instaliatlon described herein nn the dates stated:
aaicH w onh
FlNAL WSPECIION UNN7E
� Z� �
El(P6�DlABAtm011F..D OATE
:CTED IF NOT COMPLETED WITHIN 12 MONTHS
_ - - � �-rict- i,ti� r���i ., - -- - - - — / --
�c �r �� 6 —� S
�i Rough-in Inspeclion Requir�i? ❑ o Inspection OfherThan N ❑Will Call
j You must cell the inspector when ready Date Ready:
I certi(y that I am the SED CANTRACTOR ❑ COMPANY ❑ OWNER and hereby requ i�pection of e electrical work at
Jo���ddress �� f+' f �� )� . /L/ �/
Utllily
.
L
Master Elearician or
License Number
Including Area Code �
rture (Co r r� r Performing I all n) '��� Provide Two (2) Phone � mbers Includirtg Area Code
.( Y i i/� A/� � ii lD �
��i� ���riv �
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