P - 765921�� 6�'� 9 2 O � REQUEST FOR ELECy RICAL ���T`�f�7 k�
Minnesota Board of Electricit ���
` ❑ 1821 University Avenue Suite S-128, Saint au , innesota �' .: �,.,
����� (651)642-0800TTY/MRS 1-800-6273529 www.electricity.state.mn.us ����
Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Lighting Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard @$5
0 to 400 Ampere $25 Supplemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CtRCUITS / FEEDERS Transfortner / Power Su I for Si ns I 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, SIGNAIING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem 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
Lightin Retrofit $.25 per Fixture
Center Pivot Imaation Boom a(� S40
Special Inspection $30 per Hour
S ecial Inspection $.31 er Mile
THIS INSTALLATION MAY BE ORDERED DISC
I IiII II III Il i�I N il! II i� II III II III II III �� I H�
18689208
TOTAL FEE
total fee is $20) ��
I hereby certify that I inspecled Ne electrical installation described herein on the dates stated: �
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IF NOT COMPLETED WITHIN 12 MONTHS
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Rough-in Inspection Required? ❑ Yes �No Inspection Other Than Rough-In: 0 Ready Now ill 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 Sit�e'reet Address � � � City _
Township Section Range �� Fire No. County r` ��
� co'1�85�e F�vnu a. r..o
Anoka. MN 55�4
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vo (2) Phone Numbers InGuc
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Number I Master Electrician or Power Limited Technician �
.t / License Number
Nlease Pro�tle Two (2) Phone Numbers Induding Area Code
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