P - 79317. REQUEST FOR ELECTRICAL INSPECTION
������[ p O Minnesota Board of Electricity
.� J O � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
X�EL ENERGY SAVER'S SWiTCH
GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Tratfic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Amcere an $50 Transformers up to 10 KVA @$10
1
ALARM, COMMUNICATION, REMOTE CONTROL, SIG.
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Pivot Irti a6on Boom $40
�ctured Hwne Park Lots $25
Iional Vehicle Park Sites $5
te Bondin Ins tion $20
Ins tion $30 r Hour
Ins tion $.31 r Mile
iTALLATION MAY BE ORDERED
I�� �� II � II ��� ��I I�III II II) II � II � I I��
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ONE $ TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTALFEE
(minimum total fee is $20) $Z0.5Q
THiS MEA FIXi 116PECTpR USE OMV
I hereby certify mat I inspected the electrical installation described herein on the datas sta0ed:
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^w���� ��e• Fiough-in Inspection Required? ❑ Yes ❑'P�o Inspection Other Than RougMn: ❑ dy Now ❑ Will Call
Q��Q�{ You must call the inspector when ready! Date Ready.
I certify that I am the ❑�iCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby req�st inspection of fhe electrical wrork at::
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