P - 75815REQUEST FOR ELECTRICAL INSPECTION `
1� v��� 3 3 0 0 Minnesota Board of Electricity
1821 University Av uite 5-128, Saint Paul, Minnesrota 55104
` (651)642-0800 R 1-800-627-3529 www.electricdty.state.mn.us
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GENERAL FEES Out oor Liahtina Standard �$1
400
)MMUNICATION, REMOTE CONTROL,
CIRCURS OF LESS THAN 50 VOLTS
ivstem Device or Aooaratus Ccil 5.50
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit Q$.25 per Fature
Center Pivot Irriaation Boom id $40
IIII h I� �I 1� � i11 li li� I� �i � ill II �I U� I�
18813303
Transformers over 90 KVA � 20
Trensiomrer / Power Su I for SI ns / Outline Li hti $5
ONE & TWO FAMILY DWELLINGS, EACH UNff
Includes the Service and/or Power Suppty up to 500 Amperes, �II
Circufts and Two Inspection Trips Each DwelGng Unft @$80
Additional Ins 'on Tri $20
Investl ative Fee
Reins on Fee @ $20
TOTALFEE
(minimum total fee is $20) .
TIiISAREpF�tINSPECfOA ,USEpW,Y
I hereby ce�ttfy Nat I inspeded the elechical h�sla0atlon desrn'bed hereN on tlre dates stated:
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VIPLETED WfTHIN 12 MONTHS �
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Master Electridan or Power Lhnited 1
License Numher
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F _I1M1tl�e 15