P - 76346Z _ , � � � � � REQUEST FOR ELECTRICAL INSPECTION�
� � � � Minnesota Board of Electricity
�- 1821 Universily Avenue SuiCe 5128, Saint Paul, Minnesota 55104
(651) 642-08U0 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
Describe -usmg the back of th vr�ite cpPY�f nec�ary the work cover� by this r�uest:
� �r-� /�I
GENERAL FEES Outdoor Lighting Standard @$1
SPGVICFS / Df1WFR RI IPPI IFA , Traffic Sianal Standard CD $5 .
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUffS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Ap ratus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UN
3 to 12 Units Ca� $50 Per Unit
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
CircuiLs and Two InspecUon Trips Each Dwelling Unit @$60
total fee is
tacn naamonai unn L ��o ��
OTHER ADDRIONAL FEES
Lighdng Retrafit @$25 per Fodufe I hereby certify that I ihs etectrical insfaVaUnn d� heretri on the dates s�ted:
Center Pivot Irrigatlon Boom @ $40 �1 `,�y
rtaua+w
Manufactured Home Park Lots $25 •+4. d�%'�`�' f' ' aZ '( 2- C
Reaeational Vehicle Park Sites $5 �'" � °N�
Se e Bortdi Ins 'on $20 .�
Q.l,�_ � 7
S ' I� 'on @ $30 per Hour '"�0°�'D �'�
S 'aI Ins 'on $.31 per M�e
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF PIOT COMPLETED 1MTHIN 12 MONTHS
FUR QFFlCE USE CJNI'f
m �� 1
���f���i��W�I�I��I����I���I����b��� �� �- �Cd Q � Q�dr�
20994513 �l� �
`� L� ��ci�S� Cul Q.�
�%—Q% Rough-in Inspectlon Required7 �Yes ❑ No Inspectlon Other Than Rough-In: ❑ Ready Now �WIII Call
You must call tlie inspedor when readyl Date:Ready.
I cefify Urat I am tl�e �I LICEN�ED CONTRACTOR ❑ COMPANY ❑ OWNER and hsreby request inspection of the electrical work at
J°`�b�`'4�'r`� Street idlev
� XC@1
PT1Ilt I3C�flPS
Addresa
Flre No. CouMy
Please ProWd� Two (2) Phone Numbers '
� / � 1
Master EleCtrldan or
License Number
_.., -• ---._.. _.._.. _.a...__�
. NE, Spr.uig e Park, N�T 55432
or rtnh�g Insfe on) Please Provide Two (2) Phone Numbers
� � (76� 784-3729 ( )
E�
i � aneon nc Fi crtw�-v rnov -