P - 75878T REQUEST FOR ELECTRICAL INSPECTION �'`
�1. � � � � � � 3 7 � Minnesota Board of Electricity
� 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
D�rid� -usjrtg�the of the white cop 'rf - the v�ork covered by this requ�t:
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GENERAL FEES Outdoor Liahtina Standard (�a S1
I SERVICES / POVdER
AIARM, COMMUNICATION, REMOTE COPITROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Ap aratus �$.50
ADDffIONS TO THE GENERAL FEES
3 to 12 Unifs �$50 Per Unit
Each Add�ional Unit (�D $25
Traffic Signal Standard @ $5
Supplemerdal Fee @ $ZO
Transfortners u to 10 KVA (� $10
Transformers over 10 KVA $ 20
Transfortner / Power I for Si s/ Outline Li ' $5
ONE 8 NVO FAMILY DWELLINGS, EACH UNIT
Includ� the Service and/or Power Supply up to 500 Amper�, All
Circuits and Two Inspectlon Trips Each DwelGng Unit @$80
Additlonal Irrs ection Tri s$20
Inv�sticative Fee
Refis ection Fee u $20
TOTALFEE /\.
(minimum total fee is $20) �.J �
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I hereby certlfy that I U�d 9re alechical fnsta0atlon d�a�ed herefn on tM
r�lvenicleParksit� $5 "'a`ws�"a' �� _ (�c-3d''�`E'
Bon Ir�s on $ZO
spCCtion $30 PBr Hour ow�o�neanmor�n oare
specUan $.31 r NGie
ALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLEFEp WITHIN 12 MONTHS
FOR OFFICE U3E ONLY ��/
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You muat ca0 fhe inspedor when readyl Date Ready:
I certify that I am the ENSED CONTRACTOR � COMPANY ❑ OWNER and hereby uest inspection of the el�ical work at
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OdSTRUCTIONS ON BACIC OF YELLOW COPY
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