P - 76590REQUEST FOR ELECTRICA SPECTIO °°��`�
� ^ � � ��
I 1� C3' � O- 4 2 4 Minnesota Board of Electricity �� �%� .�
. 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � �
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �-�>�
Describe -using the back of the white copy if necessary - the work covered by this request: —
�(�c-�'' dIG��' -�' � ���
GENERAL FEES Outdoor Liqhtinq Standard an $1
401 to 800 Am ere $50
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit (� S25
Irrigation Boom �
i Home Park Lots
Vehicle Park Site
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer / Power Supply for Signs / Outline Liqhtin $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
Fee
total fee is $20) I p,� �-
I inspected the elecVical installalion described herein on the dates stated: �
���'�
Special Ins ion $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS __
_. __
Ii �'
1� I
Il�il IIIII IIIII I�I�I IIIlI III�� IIIII ��I� �� ��
1 8 9 0 4 2 4 3
"°"' Rough-in Inspection Required? ❑Yes �No Inspection Other Than Rough-In: ❑ Ready Nou�] Will Call
�� ���o J You must call the inspector when ready! Date Ready:
I certi(y that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrica� work at:
Job Site Str t Address
��/� �-'�� / � � City .
T �`,� �� .
Township � , � Section Range Fire No. County
Please I
� Mailing
one Numbers Including Area Code
7 �� ) -4�.�.?
� .
Name Contractor License Number Master Electrician or Power Limited l
� / _ � ���� / l� `� � l �L� License Number
l��c., 7.7�.. o�_
a , Company or Owner Perforcning Ins lation)
�c /� � �� O U e� S S�3 ��
ont ctor or Owner Perf ' g installation) -Please rovide Two (2) Phone Numbers Including Area
�r ' � T — c� /
COFYELLOWCOPY , BOARDOFELECTRICITYCOPY Gw_nnnn�e_.c