P - 76387REQUEST FOR ELECTRICAL INSPECTION ''��'��'"
2 � O���- 5 9 5 7� Minnesota Board of Electricity �� W`-� ;� I
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
C�� r ( (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ��j?�
Describ -using the bac white copy if necessary - ihe work covered by this request: ,.�
C� � ;� l.�S l - �1-1 �1- � �� S
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPLiES Traffc Si nal Standard $5
0 to 400 Ampere $25 Sup lemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 � Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I Power Su I for Si ns / Outline Li htin $5
0 to 200 Am ere $5 � Q ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s $20
Each System Device or Apparatus @$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee (a� $20
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liahtina Retrofit an $.25 oer Fixture
Recreational
Special ins ection $30 per Hour
Special Ins ection a$.31 per Mile
THIS-INST-AL.LATION4MAY.BE C
11111111111 ��111811I �'� fl lli ll lll ll lll �� l l�
�?0245957
TOTAL FEE
total fee is $201
I insoected Ne elecUical installation described herein on Ne dates stated:
.z _ _ --". 'J. /7-�'�
<CONIALETED WIT�lII+L �2 AAONIHS
.
� ���� i�� _ �:� � y � C�;,
Date: Rough-in Inspection Required? ❑ Yes �No Inspection Other Than Rough-In: ❑ Ready Now Q�Will Call
--► -a4- � , .
You must call the inspector when ready! Date Ready:
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
� I S� ��t� � jv� ^-� � v e %[. ��y �r; ��-e
Townshio Sedion Ranae Fire No. County
wpniu �.miio ^ —
� � `�+�' ' \ , ' { � � `�.�
� Electrical Utility Electrical Utility Addre
Centrafi A�re Nt :
;a. MN 55304
� n� ��
�ide Two (2) Phone Numbers Including Area Code
�I�-13� )
Master Electncian or
License Number
ct�A�a�HfiigARs&Ilation) Please Provide Two (2) Phone Numbers Including Area Code
� \ / \ /