P - 75897REQUEST FOR ELECTRICAL INSPECTION `
�� � 7 � � � � q, � Minnesota Board of Electricity _ .�
f.. 1821 University Avenue Suite 5-128, Saint Paul, Min�ta 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edecriicity.state.mn.rss
rtde -usir�g the back of the hite copy'rf Pec�ssary - the work covet�xi by this request:
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GENERAL FEES Outd�r Lighdrtg Sta�ard (a� 1
SER CES / POWER SUPPLIES Traffic Signal Siandard @$5
0 to 400 Am re @$25 Su lemerdal Fee $20
401 to 800 Am re$50 Transformers to 10 KVA $10
Above 800 Am re$75 Transformers over 10 KVA $ 20
CIRCURS ! FEEDERS Transformer / Power Su I for S' �/ Outlme Lf htl $5
0 to 200 Am re $5 ONE & NVO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOI'E CONTROL, SIGNALING Circuils and Two Inspection Trips Each Dwellir�g Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Adrifinnal Inanarfinn Trine (ii1 R9f1
3 to 12 Units
Park Lots
rpe Mile
AAAY BE
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19753144
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t0� �2@ IS $20) JD! �
I hereby cert(fythat I inspeaed tlm electriwl 6�staVatlon des��ed herein on fhe datea s�0ed:
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INECTED IF NOT COMPLETED WITh
FOR OFFICE USE ONLY
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vn�r,. Rough-in Inspecdon Requlred7 ❑ Yes �No Ir�spedion Other Than Rough-In;�Ready Now OVNO Cell I
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You must call tlre inspector when readyl Dete ReadY� Z�° 6
I cer�fy that I am the �ICENSm CANTRACTOR ❑ COMPANY ❑ OWNER artd hereby request inspection of the elec�ical work at
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