P - 75746REQUEST FOR ELECTRIC L INSPECTION �
1 a�,►,� �� � 2 q, � Minnesota Board of Electricity ��-(5 ����
1821 UnNersity Avenue Suite 5-128, Sam Paul, inneso i 5�51b4
(651) 642-0 0 TTY/MRS 1 00-627-35Z9 www.edectricity.state.mn.us
Desaibe -using the back of the white co if wo e b thi ra� �/'�
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GENERAL FEES Out oor Li hting Standard @$1
SyitVICES / POWER SUPPLIES Traflic Sianal Standard (dl $5
Above 200 Am ere �$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S em Device or params @$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units (a� $50 Per Unit
Each Additional Unit (�D $25
� � eT101d MAY BE ORDERED_
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18591245
Transformer / Power Su I tor Si / OuNine Li hti $5
ONE & T1N0 FAMILY DWELLINGS, EACH UNR
Indudes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Ir�specGon Tdps Each DvreVing Unit @$60
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Additional Ins 'on Tri @ $20
Inv�,figative F�
Reir�s 'on Fee $20
TOTALFEE
(minimum total fee is $20)
1HISN§APoN WS EC(OR USE O�LLY
I hereby certiythat I hispeded tlre electricel inslafledon desaibed Irerein on fhe dates shated:'
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dIPLETED WITHIN 72 MQNTHS y
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g pection Required9 Y� ❑ No InspecUon Othar Than Rough-In: ❑ Ready Now W�I Cell
You must call the inspector whe dyl Date Ready.
1 certify that l am the LICENSED CONTRACTOR � COMPANY ❑ OWNER and hereby r�uest inspection of the el�tric�l work at
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