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P - 76191REQUEST FOR ELECTRICAL INSPECTION � 2� O� 6' � 411 � Minnesota Board of Electricity 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 (651)642-0SOOTTY/MRS 1-800-6273529 www.edectricity.state.mn.us Dascribe - i g e back�f the w' copy'rf n� - e cover� by this request: v�•—y°�- . GEN FEES Outdoor Lighting Standard @$7 SERVICES / OWER SUPPLIES Traffic Signal Standard @$5 __ AU1RM, COMMUNICAl10N, REMOTE CONTROL CIRCURS, CIRCUITS OF LESS THAN 5D VOLTS Each S stem bevice or Ap �aratus @$.50 ADDITIONS TO THE GENERAL I Center Pivot Irtigatlon Boom @ Manufactur� Home Park Lots ONE 8 TWO FAMILY DWELLINGS, EACH UNfT Ir�cludes the Service and/or Powrer Supply up to 500 Amperes, All Ciraiits and Taro Insp�on Trips Each Dwelling Unit @$80 total fee is i n�en�r c�rarr met i�aea are etearmei �non a�cn�a nera� o� nre asr�s �ma: � �1' 3 -��' � FOR 6PPiCE UuE ONL�' ������������������������������������������i U � -��- /�- � , 20E�74115 � �. Date: �gh-in Inspadion RequUed9 ❑ Yes Inspecllon Other Than R h-In: Naw ❑ Wi� Ce� You must call the Mspector when readyl Date Ready. I certify that I am the�l ENSED COMRACTOR ❑ COMPM�I f❑ OWNER and hereby request inspection of the electrical work at u �,�:�.. ��� D'' � l�-S ) � ��' Master Electridan or Power Limited Licerise Number ro(2) Phorre Numbers Induding Ar� Q?�t� ( ) � FR-fMN1�A-1�.