P - 79112REQUEST FOR ELECTRICAL INSPECTiON
1�� o O- 4 b 6� Minnesota Board of Electricity � _
1621 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
C�- i.�aoa (651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
0 NEW REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
C�:S a j l-'i 1-? -�g�5
GENERAL FEES Outdoor Li htin Standard $1
SERVICES i POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Am re $50 Transfortners u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transfortner I Power Su I for Si ns / OuUine Li htin $5
0 to 200 Am re $5 v ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andbr Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspecfion Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri $20
E�h S stem Device or aratus $.50 Investiaative fee
ADDITIONS TO THE GENERAL FEES
fIFAMILY DWELLIN�S PER UNI
3 to 12 Units �$50 Per Unit
Boom
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17004664
(minimum total fee is $20) � pCO''—
TMS PRFA Fpt RLSPECTIXt 115E 0'LY
I hereby certify Ma�tyinspecled the elec6ical insiallation described herein on tlie Gffies s1�d:
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ReQuest D�e: �
ROU9hi^ ��sP�tion Required? y�
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I certify ttiat Fam 1he 1�![ICENSED CONTRqCTpR OCpIu�,4Nlr p �yyNER and
�on siie ndaess �snee�, ��e No.) l herebY request mspection of ttie electrical work at:
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