P - 82453REQUEST FOR ELECTRICAL INSPECTION
1 0 3 2 117 �� a Minnesota Board of Electricity
�. � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-6273529
- www.electricity.state.mn.us
Identity the work covered by this request: �Q n n�.�
❑ NEW ❑ REMODEL �LADDITION EPAIR
GENERAL FEES Outdoor Li htin Standard (� $1
SERVICES / POWEF SUPPLIES Traific Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re �$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 Min �$5
0 to 200 Am ere �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and�or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri �$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENEHAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to t2 Units �$5o Per Unit (minimum total fee is $20)
EeCh Additi0nal U�it �$25 f0f1111SPECTdi USE ONLY
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fxture
Cerrier Pivot Irri atlon Boom �$40
Manufactured Home Park Lots �$'15 � hereby ced;ty that I inspected tl�e electrice� installauon d�cribed herein on tl�e dates siffied:
RecreaUOnal Vehicle Park Site FOUGH IN °"�
S rate Bondin Ins ection
S ecial Ins ection �$30 er Hour �°` ��
S ial Ins ection �$.31 r Mile �
__�THIS IW$T_ALLATIO_N MAY BE ORDERED DISCONNECTED IF OMPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ❑ WiH Call
b�oO You must call the inspedor when ready! Date Ready:
! certify that I am the �LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecirical work at
Job Address (Street, Box, or Route No.) U C� i� l Z��y 3 a
� H.�
Section Township Range Fire No. �
Occupant Phone
l- rr i S
Power Suppli Address
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Electrical Contractor / Company Name CoMractor License Number Master Ucense Number
DEPENDABLE ELECTftIC, iNC. C�1-D�Co3�P C- 3
I ([�qn P�p�jryod, erforming Installation)
Coon Rapids. MN 55433
Authorized Signature (CoMracto pany or Owner Perfo ng Instatlation) Phone
l� -'75 -
E8-OOOOtA-13 7l1/2000 BOAHD OF ELEC'TFiICRY COPY INSTFiUC710N3 ON BACK OF YELLOW COPY