P - 76323'�_ °`' REQUEST FOR ELECTRICAL INSPECTION � j,� '
1��� 0�� 7 8 � Mirtnesota Board of Electricity `
1821 Univers i ty Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy'rf n�ry - the rk covered by this request:
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GE FEES Outdoor Li hti Standard @$1
SERYICES / POWER SUPPLIES t Traffic Sianal Standard (�D $5
Above 800 Am r
CIRCUITS / FEEDERS
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Ap araWs @$.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWEWNGS PER UN
3 to 72 UniLs a(�. $50 Per Unft
Center Pivot Irripatlon Boom
� Transformer / Power Supply for Signs / Outline LigMing @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amper�, All
Circuits and Two Ir�spectlon Trips Each Dwelling Un@ �$80
TOTAL FEE I � `,� ` �
total fee iS $20) U
I herebvi certlTv ihat I fnsnected fhe eledrical insta�ad�on desa�ed I�ein on fhe dates atated: I
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
F(3R QF'FICE USE 01LY
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18202788
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''4 �,7 D��j� You must ca0 the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY 0 OWNER and hereby request insp�tion of the eleetrical work at
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