P - 77432/� REQUEST FOR ELECTRICAL INSPECTIO b��`�
1.:� � bi, � �r 5 � 9 � Minnesota Board of Electricity � OQS ` (�� ��p� � �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 551�4
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(651) 642-0800 TTYIM RS 1-800-627-3529 www. electriciry. state. mn. us
Describe -usin a of t whi copy if sary - the w coveredby this requ :
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GENE L FEES Outdoor Lighting Standard (� $1
/ICES / POWER SUPPLIES
0 to 400 Amoere aC� $25
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus a$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units la� $50 Per Unit
Irrigation Boom
i Home Park Lc
Vehicle Park Si
ALLATION MAY BE ORDERED DI;
� IIII II III II III II 111 II III II III II III II III �� I�
18435990
Traffic Si nal Siandard $5
Supplemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
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
Additional Ins ion Tri s $20
Investi ative Fee
Reins ion Fee $20
TOTALFEE
(minimum total fee is $20) �
THIS MEA FOR INSPECTIX2 USE ONLY
I hereby certify that I inspeded the electrical installation described herein on the dates stated:
ROUGHIN DFTE
FINPIINSVECTION pq�
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exPiReo�neu+oonEU on�
;CTED IF NOT COMPLETED WITHIN 12 MONTHS
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577 SHOREVIEW PARK ROAD
�,��pN� MN 55126-7014
� r-t;ompanv or Owner Perfom
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Master Electrician or Power Limited
License Number
PHONE: (651) 490-1333
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FR11fIM1A_1•