P - 77720REQUEST FOR ELECTRICA INS ECTION �
� �.d 8� 5� 8�� � Minnesota Board of Electricity p�(���—Qa�Lf� �-�
1821 University Avenue Suite S-128, Saint Paul, innesota 5 li4
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
necessary - the wonc covered by this reque
. �� 3s
� Outdoor Liahtina Standard (d $1
0 to 400 Ar
401 to 800
Above 800
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus a$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units an $50 Per Unit
Irrigation Boom C
i Home Park Lots
Vehicle Park Site:
�LLATION MAY BE ORDERED
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18558577
Su plemental Fee $20
Transformers u to 10 KVA $10
Transfortners over 10 KVA $ 20
Transfortner / Power Su I for Si ns / Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additionai Ins ion Tri s $20
Investi ative Fee
Reins ction Fee $20
TOTAL FEE
(minimum total fee is $20) �� �Q
I hereby certify that I inspected the eledrical installation desaibed herein on the dates stated: �
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2EDIA84NWNED pp}E
'ED IF NOT COMPLETED WITHIN 12 MONTHS ________
;�r�ce _ �_=.�;
Date: Rou h-in In
/�,� � D� g spectlon Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ill Call
7 You must call the inspector when ready! Date Ready:
I ceRi(y that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecfrical work at
Job Site SVee'A� . n �' ��y . n n
1� /� J
I Eledrical
.�[racror,�ompany or uwner
N�
iture (Contractor or OwrV er
,
BACK OF YELLOW COPY
Utility Address
Fire
\ / \ �
a�r./ucense Number� Master Electrician or Power LimRed Technician
i� oo C� S License Number
7 7u
/ �X��
Please Provide Two (2) Phone Numbe Including Area Code
f763) 33s-6e•c� ( )
COPY FR_Mf1fItG_14 A 1 ���n