P - 77664/� REQUEST FOR ELECTRICQ��t�S�E�T���
1���F �= 3 31 � Minnesota Board of Electricity oC (JS ol �
7821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
W 0 ODEL ❑ AD TI REPAIR �� using th back of fhe white copy if n�cessary - ihe covered by this request:
./I Yc�. �� /.. `'4-r _ � %1n �r J f �.� �� �/GC..
Above 200 Ampere @$10
2M, COMMUNICATION, REMOTE CONTROL
;UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL I
iIFAMILY DWELLINGS (PER UNIn
3 to 12 Units @$50 Per Unit
Each Additional Unit � S25
OTHER
Lighting Rehofit @ $.25 p
Center Pivot Irtiaation Ba
�n �III (IIII II�I� IIIII II I�I (IIII IIIII �� IIIN
16493314
Traffic Si n� Standard $5
Su demental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li hGn $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes fhe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
Fee
(minimum total fee is $20) � � • , �—
TMIS MFA Fqi INSPECTOR lISE ONLY
I hereby ceAify that I inspected the ekc6ical instalt�on described the d
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C
K���/� Rough-in Inspection Required? ❑ Yes �Mo Inspection Other Than Rough-In: Ready Now ❑ Will Call
��G! You must wll the inspector wfien ready! ` Date Ready:
I certiry that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: