P - 77703REQUEST FOR ELECTRI L IN.�P C�IQ /� ��`�
I Q�j Minnesota Board of Electricity ��� � 04:1� p �. �i ��
�� aJ 1�- 3 5 7 0 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 of the w' copy'rf neces�ry • the wo�C cov� this requ s�
I SERVICES /
C
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus @$.50
ADDITiONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liqhtinq Retrofit af� $.25 oer Fixture
Lots
Traffic Signal Standard
Suoolemental Fee an $
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiqative Fee
TOTAL FEE
total fee is $20)
I hereby certAy that I inspeded ihe electrical installation described herein on the dates stated: I
ispection $30 p@f HOU� exaiaEO�naneoc
ispection @ $.31 per Mile
ALLATION MAY BE ORDERED DISCONNECTED IF
I��I II II� ii i�� II II i) lil I�' I I III II I�I II I� I�n
18783571
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APLETED WITHIN 12 MONTHS
Date: Rou h-in Ins ection Re uired?
.�� ' O g p q ❑ Yes ❑ No Inspection Other Than Rough-in: Ready Now � Will Call
_ You must call the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address ��y��� I
� l S' - �� ��° J1Jf
I Electncal UtilRy ' � 1 — Electri
/
Cont / Company Name �—
�PENDABLE ELECTRIC, INC.
�,rMailing Add �f¢ pxy��kr.Aerformin
, •-r^ oiv�i
Coon Rapid�. MN 55�33
� Authorized Siana ntractor or Owner rformina In�
Range Fire No. County
� Please Provide Two (2) one P
, __ ,c �a -_�,
Please Provide
�_ iT t�_
Master Electrician or Power Limited
License Number /1 .n..�.