P - 75460REQUEST FOR ELECTRICAL INSPECTI�N �°
`� � � � o � � � � Q �Vlir�esota Board of Electricity
L �� .�1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 _
(651) 642-0800 TTY/MRS 1-800-627-3529 www.edecrizcity.sdate.mn.us
Describe -usmg the back of the whde copy'rf necessary - the work cover� by this request:
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GENERAL FEES Outdoor Lighting Standard (a� $1
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
CIRCUITS OF LESS THAN 50 VOLTS
iystem Device or Apparatus @ $.50
ADDITIONS TO THE GENERAL FEES
CeMer Pivot Irtigation Boom �
Manufadured Home Park Lots
� THIS INSTALLATION MAY BE ORDERED [
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18204669
Transformers u to 10 IMA $10
Transformers over i0 KVA @$ 20
Transfortner I Power Supply for Signs / Outlme Lightlng @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNR
Includes the Service and/or Power Supply up to 500 Am�res, All
Circu�s and Taro Inspection Trips Each DwelGng Unit @$8
(minimum total fee is $;
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I herebv �rtifv'thgt �Insaec4e'3d the eltctrical hc
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described hereinJac�e dates sfated: I
FC�R OFFlCE USE OPlLY
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�� Rough-in Inspectlon RequUed? �Yea �No Inspectlon Other Than Rough-In: � Ready Now �WN Catl
��� �� You must call the inspector when readyl Da[e Ready:
I certify am the ❑ LICENSED CONTRACTOR ❑ COMPANY �OWNER and hereby request inspection of the electrical work at
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