P - 76254REQUEST FOR ELECTRICAL INSPECTION '
� ����� � � � � IVlinnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. .(651) 642-0800 TTY/MRS 1-800-627-3529 www.edectriciry.state.mn.us
Describe -using the back of the white copy ff n�essary - the work covered by this request:
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GENERAL FEES Outdoor Li4h6na Standard id. $1
401 to 800
Above 800
CIRCURS OF LESS THAN 50 VOLTS
iystem Device or Apparatus @ $.50
ADDITIONS TO THE GENERAL FEES
Center Pivot Irtiaation B�m
THIS INSTALLATION MAY BE ORDEREO
IIIII IIIII iilll III{I I�III II�I Illll IIIII Q� i�
�1024690
Transfortners over 10 KVA $ 20
Transformer / Power Supply for Signs / Outline Lightlng @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includas the Service andlor Power Supply up to 500 Amperes, All
Circuits and T�vo Inspection Trips Ead� Dwellim� Unit @$80
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Fee
TOTAL FEE I � . �
total fee is $201
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IF NOT COMPLETED WRHIN 12 MONTHS _
FOR OFFtCE USE OtdLY
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�� Rough-in Inspedlon Required? ❑ Yea a inspection Other Then Rough-In: � Ready Now ❑ Wt0 Call
�'°� °� You must cell the Inspedcr when readyl Date Ready:
I certify that f am the � LICENSED CONTRACTOR � COMPANY � OWNER and hereby request ins{�ction of the electrical wmk at
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�ber Mea�r Electridan or Power L6Nted Technidan
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'rovfde Two (2) Phone Numbe�s Irtcludtr�g Area Code
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