P - 75860REQUEST FOR ELECTRICAL INSPECTION
�� 9 21- 9 5 7� Minnesota Board of Electricity ; ,
1821 Universiiy Avenue Suite S-128, Sairrt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.edectricity.stote.mn.vs
Describe -using the bacic of the whlte copy if nec�sary - the work covared by this request:%j� J/ �C.�
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ENERAL FEES Outdoor Lightin Standard $1
SERVICES I POWER SUPPLIES Traffic Sianal Standard (�D S5
IALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Unit @
Lightlng Retrofit @ $.25 per Fbdure
CeMer Pivot Irriaation Boom a(�. $4(
THIS IMSTALLATION MAY BE ORDEREC
luu �UI �III IIIII IIIII IIIII I�III UIU �� I�
L9219575
Transformers u to 10 KVA $10
Transformers over 10 KVA �$ 20
Transformer / Power Supply for Signs / Outiine Lighting @$5
ONE 8 TlNO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Tdps Each Dwelling Unit @$80
TOTALFEE
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I hereby wAifytl�at I U�spec0ed The elechiial des�aibed herefn on ttre dat� stet�:
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:CTED IF NOT COMPLETED WITHIN 12 MONTHS ___
���OFFICE USE ONLY�
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�^ Rough-in Inspectlon Required9�Yes ❑ No InspecUon Other Than Rough-In: � Ready Now ❑Wi0 Cell
l � Z �� You must call the Ir�apector when readyl Date Ready.
1 rti(y that I am the LICENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request inspection of the elec4ical work at
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�ertortning Instellation) Please Provide Two (2) Phone Numbers
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