P - 77443REQUEST FOR ELECTRICAL INSPECTION n �
,��6 4 1� 6 8 7 � Minnesota Board of Electricity ��� :
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�� ��' (651) 642-0800 T'fY/MRS 1-800-627-3529 www.electricity.state.mn.us
❑ NEw MODEL O ADDIT N❑ REPAIR Describe -using the bxk of the white copy if necessary - the work covered by this request:
C�o� o��0 51- r 'i � �'S
GENERAL FEES Outdoor ' htin Standard S1
SERVICES I POWER SUPPLIES Tra(fic S' nal Standard $5
0 to 400 Am re $25 Su ement� Fee $20
401 to 800 Amcere � E50 i, Tr�sfortners up to 10 KVA �$10
00 Am e S5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
: 200 Am re $10 Includes ihe Service andlor Power Supply up to 500 Amperes, All
OMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspecfion Trips Each Dwelling Unit �$80
, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 6on Tri $20
S stem Device or aratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins tion Fee $20
dILY DWELLINGS PER UNIT TOTAL FEE �O
2 Units @$50 Per Unit (minimum total fee is $20) Q
Additional UnR �$25 *ws nREn Foa wsaECroa usE «a.
I hereby tertify tl�at I inspecled the elettrical imtaNa6on described hereia o� tlie d�s sfa0ed:
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