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:
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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: �
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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
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Master Electridan or Power Limited
Licerise Number
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