P - 77694r� REQUEST FOR ELECTRICAL,�NSPECTION
1�� 4 U—� 6 2 � Minnesota Board of Electricity ��/���_��� -
1821 University Avenue Suite S-128, Saint Paul, innesota
(651) 642-0800 T'fY/MRS 1-800-627-3529 www.electricity.state.mn.us
O NEW O REMODEL ❑ ADDITION ❑ REPAIR Describe - ing the back of thqwhite copy if necess�y - the work covered by this request:
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GENERAL FEES . 1 1/ I Outdoor Liahtina Standarcl
SERVICES I POWER
Transformers u to 10 KVA $10 — J
Transformers over 10 KVA @$ 20
Tr�sformer / Power Supply fw Signs I Outline Lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each 5 stem Device w atus i.50 Investi alive Fee -
ADDITIONS TO THE GENERAL FEES Reins Gon Fee $20
fIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 Units @$50 Per Unit (minimum total fee is $20)
Exh Additional Unit � $25
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I hereby certlry Mat I inspecOed the electrical install�on described icerein on the dates stated:
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arate Bondin Ins tion S20 +--�--� �<' n
S iallns 'on S30 HOUr E"""EOi"a''r°°"F° °"'E
S iallns 'on 5.31 Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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L�Q�� �e: � Rough-in Inspection Required? LI Ves ��lo Irupection Other Than Rough-In: �Rea^NOw � Will Call
y�/� � You must call the inspecta when ready! Date Ready. �� Z� •�+S
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I certify that I am the �410ENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::