P - 75871REQUEST FOR ELECty RIC�L IN ��TJ�O�N
1—.� �: �� 8 2 g � Minnesota Board of Electric y
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� ��� 7� (651) 642-0800 TTY/MRS 1-800-627-3529 ww�v.edectricity.state.mn.us
D�ai� -us the back of th ite copy'rf nec�ssary - the work cover� by this request:
� �..�� i ' �%�7 -�g�S
GENERAL FEES Outdaor Liqhtirm Standard C�D $1
3 to
IMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
Home
'ALLATION MAY BE ORDEREC
I IUI ��� u) I� II) II II) II III I) III II �I �� I�
19298298
Transformers u to 10 KVA $10
Transfomrers over 10 KVA $ 20
TransFormer / Power Su I for Si s/ Outline Li htln $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Indudes the Service andlor Power Supply up to 500 Amperes, M
Circa�iis artd Two Inspec�on Trips Each Dwelling Unit @$80
Addi�onal I on Td $20
iti
Imasti ative F�
Reins 'on Fee $20
TOTAL FEE �
(minimum total fee is $20) � �
nus a�a Foa usr�crors usE anr
i nereny �tym�c i�aum ere� �non d�d n�earon me a� sia�a:
�,� ��
IF
e--��"o
!'OR OFFkCE USE OP�I.Y � (�—+ �
�.�- g---�
uaie: Rou h-in on R uired7 ❑Y� �o I I
''') �1^ 9 ��P� eq r�spedian Other Than Rougfi-In: ❑ Ready N Wi0 CaA
1�� p[ /��✓ Yau must caA the inspec[or when readyl Date Ready.
I certity that I am the [�CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eledrical wark at
.bt, sroe sveet aaar�s ��y
�1� �' � �e.(G�� Y, � � �� �r� �l.l�.,�
1R N8rti8 ��� ,�
�
a
`� s�l-�a(�( )
lumber Ma�ter Eledridan or Paeuer Limfted 1
� � License Number
se Provide Two (2) Phone Numbers Including Area
3)?57°G�'niC�.� )