P - 76199REQUEST FOR ELECTRICAL INSPECTION °��'�°
2� 14`�`�� � 4 0 �innesota Board of Electricity .
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edechzcBty.state.mn.us
Describe -using the back of the wrhite copy'rf necessary - the work cover� by th' request:
Id� C a G �le� ��? �'C.� 4.� �� K � �r-
GENERAL FEES Outdoor LiqMum Standard (� $7
0 to 400
ALARM, COMMUNICATtON, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each stem Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit @
OTHE
Liahtina Retroffi Cd $.2:
Ttansformers over 10 KVA $ 20
� Transtormer / Pouver Supply for Signs / Outline Lighting Q$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Inciudes the Service and/or Power Supply up to 500 Amperes, All
,�ircuits and Two InspecGon Trips Each Dwelling Unft @$80
TOTAL
total fee is ;
t
I harebv cer6N fhat I insoeded fhe eledrical inslallatlon desrn'bed herein an the dates at�ed: I
W W�
Se rateBondi Ins 'on $ZO �GL^—�^� �— 1.:L "r�
S al Ins 'on @$30 per Hour °�D'"B""m0"� °ATE
S ial Irrs 'on @$.31 r Mlle
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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��� Rough-in Inspedion Required? ❑Yes o Inspedion Ofher Than Rough-In: eady Now � Wm Call
�(�(�i�� (� ou must call the inspedorwhen readyl Date Ready: � �
I certify that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby requast ins�ction of the electrical work at
Job Site Str�t Address Cfty
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