P - 75793REQUEST FOR ELECTRICAL INSPECTIOIV
1 a � � � � � � � � Minnesota Board of Electricity 4 -`
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
��rj$ (651) 642-0800 TTY/MRS 1-800-627-3529 www.edectrictty.state.mn.us
D�scribe -using the back of the white copy if n�sary - the work covered by this requ�t:
Replace storm damaged service entrance mast.
GENERAL FEES Outdoor LigMm Sta�ard @$1
SERVICES / POWER SUPPLIES /h Traffic Sipnal Standattl (�a $5
Above 200 Am aere �$10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCllITS, CIRCUITS OF LESS THAN 50 VOLTS
THE GENERALFEES
3 to 12 Units @$50 Per Unit
Each Addfional Unit f�a S25
AAAY BE ORDERED
( I�II �I (II �I I� (I II� I� I� � III II III II II� �� I�
18391995
ONE 8 TWO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Ir�specUon Trips Each DweQing Unit �$80
Add(tional Ins on Tri @ $20
Inv�stigative Fee
Reins 'on Fee $20
TOTALFEE
(minimum total fee is $20) $ 3 0. 50
nos a�a r� usrECroa ug a�a.r
I herebY cerd�Y that I� fhe el�ricel NstaOatimi descnbed herein on the dates st�ed:
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NPLETED WITHIN 12 MONTHS
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Date: Rough-in InspecUon Required9 ❑ Yes � No Inspadion Ofher Than Rough-in: � Ready Naw �VY� Cell
03 / 02 / 06 You must cell ttie Inspector when readyl Date Ready.
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby reAuest inspeefion of the electrical work at
. INSTRUCTIONS ON BACK OF YELIOYY COPY BOARD OF ELECTRICT' COPV Fw_nmm� e_�t o � onnn