P - 77408REQUEST FOR ELECY RICAI�I��TIOi�I �`°�
1� v J�= 4 5 3 0 Minnesota Board of Electricit ,� -����� �- ;�
1821 University Avenue Suite 5-128, Sai�t Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 x1ro�x�.electricity.eta�e.mn.us � ��
Describe -using the back ot the white copy if necessary - the work covered by this request: �-�—
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GENERAL FEES Outdoor Lighting Standard $t
SERVICES I POWER SUPPLIES Traffc Signal Standard $5
0 to 400 Ampere $25 C r Supplemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin $5
0 to 200 Am re $5 ONE & 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 Dwelling Unit @$80
CIRCUITS, CiRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20
Each System Device or Apparatus @$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to t2 Units @$50 Per Unit (minimum total fee is $20)
EeCh Addlti0�el Unit (� $25 �nisnRenFOeiNSCecroaus oN�v
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Irrigation Boom
i Home Park Lc
Vehicle Park Si
the elecMcal installation described herein on the dates stated:
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SpeGal Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS _
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18984534
Date: �� Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now ❑ Will Call
� You must call the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Addr City
1`l 1 5' S� n�� Fl���l�
Township Section Range Fire No. Countv
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�t,��tY -
HANNAY ELECTRIC INC.
27549128TH STREET N.W.
ZIMMERMAN, MN 55�9$
turelCon[ractor or 04mer Performino Installarinnl
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INSTRUCTIONS ON BACK OF
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BOARD OF
Please Provide Two (2) Phone Numbers
(16��7J-17S3( )
rr License
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Please I
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COPY
aectnaan or Nower Limited 1
Number
�ne Numbers Including Area
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