P - 75868REQUEST FOR ELECTRICA�SPECTION - �' .
1� J 1�- 9 6 6� Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint aul, Minnesota 55104
°�'� (651) 642-0800 TTY/MRS 1-800-627-3529 www.elecrizcity.state.mn.us
escn'be -usirtg the back of the white copy the work covered by this requ�t:
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GENERAL FEES Outdoor Lightin Standard $1
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 Am re@$25 Su lemental Fee �$20
401 to B00 Am re$50 TransFormers u to 10 KVA $10
Above 800 Am re $75 Transfortners over 10 KVA $ ZO
EIRCUITS / FEEDERS Transfortner I Power Su for Si I OuUine Li htin $5
0 to 200 Am re $5 & TWO FAMILY DINELLINGS, EACH UNIT
Above 200 Am re$10 Inctud� the Service andlor Power Suppiy up to 5D0 Am{�res, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspectlon Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addltional Irrs 'on Tri $20
Each System Device or @$.50 Imestigative Fee
ADDff10NS TO THE GENERAL FEES Reir�saection Fee C�a. $20
CeMer Pivot Irriaatian Boom
TOTALFEE
total fee is $201
I herebv cmtlfv that I hsueded the etec4ical InstsVatlon d�a�d herein on fhe dat� siai�: I
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dbn @$.37 per Mile � �
.LATLON MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
�OR OFFiGE USE ONLl
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�/�� Rough-in Inspectlon Required? ❑ Yes No Inspec�on Other Than Ro�h-In: 0 Ready Now Call
� V 1"C r�O - You must cell the kispector when ready! Dahs Ready.
I certdy that I am the LICENSED COMRACTOR ❑ COMPANY � OWNER and hereby request inspe�ion of the electrical work at
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