P - 75827REQUEST FOR ELECTRICAL INSPECTION � �'
I � � � � � �, � � � � Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800't�'Y/MRS 1-800-627-3529 www.electricddy.state.mn.us
DJ��_'j' be -using th oF the white co ff nec�ssary - the work covered by this request:
�S/ �FA ` �
ENERAL FEES Outdoor Li hting Standard $1
SERVICES / POWER SUPPLIES Traffic Signal Standard $5
0 to 400 ArtIDEle (02 $25 � S�mnlamaMal Fac, !dl 470
I MUL
CIRCUITS OF LESS THAN 50 VOLTS
>vstem Device or Ao�araws ld $.50
�
Fodure
Transformers over 10 KVA $ 20
Transformer / Prnaer Suppty for Signs / Outfine Lighhting $5
ONE 8 TbVO FAMILY DWELLINGS, EACH UNIT
I�lud� the Service andlor Power Supply up to 500 Amperes, Atl
Circuits and Two Ins�on Trips Eech Dwelling Unft @$BO
TOTALFEE C�
total fee is $201 �5�
I hereby cettify fhat I inspeded tlre ele�triwl histeVatlon d�cn'hed herein on tlre dates s�ted:
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5 Ins 'on $.31 per Mile
THIS INSTALLdTION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
FQR OFFICE USE ONLY
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'�+�� � You must call the inspedor when readyl Date Ready:
I certify that I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elec6ical work at
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BACK OF YELLOW CO BOARD OF ELECTRICT' COPV va_nnnn� e�e o. enn.