P - 77145REQUEST FOR ELECTRIC/;#��� ECTIQN �"��`��
� 1 $� � 3 4 4 � Minnesota Board of Electricity p( �( /� 4 �
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota ��4 �. `�
(651) 642-0800 TTYIMRS 1-800-6273529 www.electricity.state.mn.us ��';��
Descri - sing the back of th hite copy if necessary - the work covered by this request:
ERAL FEES Outdoor Lighting Standard (a� $1
I SERVICES I POWER
1 Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus (� $.50
2 Units @ $50 Per Unit
Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriqation Boom an $40
Traffic Signal Standard
Supplemental Fee @ $
Transformers up to 10 I
Transformers over 10 N
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investi ative Fee
Reins ection Fee $20
TOTALFEE O. �/^�
(minimum total fee is $20) U
THIS AREA FOR INSPECTOR USE ONIY
I hereby certify that I inspeded the electrical installation described herein on the dates stated:
Se arate Bondin Ins ion $20 =c��— � Z— jc*-�U
SpBCl21 If1Sp2Cti0n $30 p2f HOUf exPiaeornenr�oorveo onrE
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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18813444
vate: I Rough-in Inspection Required? ❑ Yes � Inspection Other Than ough-I y Now ❑ Will Call
IYou must call the inspector when ready! Date Ready: �D �l/J��
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I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site S eet Address City
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Township Section Ranae Fire No. Countv
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Number Master Electrician or
-f F�►'� License Number
s�rov�tl� Two (2) Ph� bers Including Area
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