P - 77536REQIi�� i �•�R ELECTR�c � ��J, _
I1�.$ 2��� V g � Minnesota Board of Electricity ��� _ Tul tre��85�0�
1821 University Avenue Suite S-128, S int aul, in a �.__
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(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us "'
Describe -using the back of the white copy if necessary - the work covered by ihis request:
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GENERA FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES . Traffic Si nal Standard $5
0 to 400 Ampere $25 � t� Sup lemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Ampere @$75 _._ Transformers over 10 KVA na $ 20
� Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit (a� S25
Center Pivot Irriqation Boom
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Addftional Ins ion Tri s $20
Investigative Fee
Reinspection Fee $20
TOTAL FEE �
(minimum total fee is $20)
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I hereby certify that I in eded the el 'cal installation des erem o the da es stated:
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Special Inspection @$.31 per Mile ��- ZO � c�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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18204891
Date: Rough-in Inspection Required? �,Yes ❑ No Inspedion Other Than Rough-In: ❑ Ready Now�Will Call
il�u� Je► �� You must call the inspector when ready! Date Ready:
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I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at