P - 75739� " REQUES t F�R �LECTRICA INS ECTIO
1 � � �"� � � 6 � 2 � Minnesota Board of ElecUicity ' p�Ql7� — �! ���
1821 lJniVBrsity Avenue Suite 5-128, Saint Paul, nesota 55104
(651) 642-d800 TTYlMRS 1�00-627-3529 www.edectricity.state.mn.us
Desctibe -using the back of tha ite copy if - the work. c�vered. by this requ�t: �
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GENERAL FEES Outdoor Liahtlrro Slandard C1a $1
: 8Q0 AmPen
/FEEDERS
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units CD. $50 Per Unit
INSTALLATION NIAY BE ORDEREI
I I�U II ul � W�I �I II lu � III �I lu II ��� I�
18546820
Transformers up to 10 KVA
Tra�sformers over 70 KVA
Includes the Service andlor Power Supply up to 500 Amperes, All
Ciraiits and Two Ir�specUon Trips Each Dwelling Unft @$80 .
Additional 1� 'an Tri $20
Imestlgatnre Fee
Reins on Fee $20
TOTALFEE
(minimum total fee is $20 S ,
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I hereby certlfythat I 6ispeded ths electrlcal insta�atlon d� h�eln on Um dates a�ted:
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IF NOi COAAPLETED VWTHIN 92 MONTHS �
r-oR oFFtce use oN�v
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o�: Rough-in Inspedion Requhed7 �'es � Plo Inspedidn Other Than Rwgh-Irr. � Ready Now �WOI CaA
?j% �'S You must cell tlre inspedor wheA readyl `- Date Ready:
I ce ' ttrat am the I�ICENSED CONTRACTOR ❑ COMP,4NY Ck7 OWNER ar�d hereby iequest inspection of the electrical vuork at
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r / Company Name Cordr�
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MaAing Address (Contrador, Company o Owner Pertartning Instellatlon)
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orized S ( Mra o Owner Pe rming Installation)
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Pl�se Provide Txro (2) Phone Numbers Im�u�Hng Area Ca
(��3) s� y �36�( - )
ise Number Master Dedridan or Power Ltmited Tech
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Please Provide Two (2) Phone Numbe�s Inciudhig Area Ca
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