P - 77409REQUEST FOR ELECTRIC INSP C I N �
Minnesota Board of Electricity o�� �I� �.
1� g 9�= 4 5 2 0 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � �� �
(651)642-0800TTY/MRS 1-800-627-3529 x�ww.electricity.state.mn.us �,��
D scribe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standard @$1
SERVICES / POWER SUPPLIES , � Traffic Siqnal Standard (a� $5
401 ta 800 Am ere $50 '
Above 800 Am ere $75
CIRCUITS / FEEDERS
D to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CANTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li hting Retrofit $.25 per Fixture
Center Pivot Irriaation Boom an $40
Special Inspection $30 per Hour
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED
Ilil II III II III !I III iI II! II III II ilI II III � III I iili
L8984526
Transformers over 10 KVA $ 20
Transformer / Power Supply for Signs ! Outline Lighting $5
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 Inscection Trios na $20
TOTALFEE
(minimum total fee is $20) j -
I hereby certiry thal I inspected the electrical installation described herein on the dates stated:
. �G'
APLETED WITHIN 12 MONTHS
I 1°"� (/ ^� Rough-in Inspection Required? ❑ Yes � No Inspection Other Than Rough-In:�Ready Now ❑Will Call
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I/ sl s.�ICfGH u You must call the ins ector when read �
�v v�c_i �-� P y. Date Ready:
I certify that I am the �LICENSED CONTR,4CTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address
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I �°�'�' -�-- ��- -HANNAY ELECTRIC INC.� �°°``�°�
Mailin 27549128TH STREET N.W.�> -
ZIMMERMAN, MN 55398
; Authori Signature (Contra o or Owner Performino Installationl
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Fire No. County
Please Provide Two (2) Phone Numbers
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�er Master Electrician or Power
5'^ License Number
Please Provide Two (2) Phon
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Area Code
Area Code