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P - 78288REQUEST FOR ELECTRICAL INSPECTION � r Minnesota Board of Electricity �- 0 3 2�� O� �82� University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-500-627-3529 www. electri ci ty. state. mn. us IdeMify the work covered by this request: EW ❑ REMODEL ❑ ADDITION ❑ REPAIR L✓ l� v i�-%�! �-�- GENERAL FEES Outdoor ' Min Standard �$1 SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5 0 to 400 Am re �$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 / Power Su I for Si ns / Outline Li htln (� $5 0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Above 200 Am re �$10 Includes the Service and/or Power Suppy up to 500 Amperes, All ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellinq Unit �$80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each S stem Device or A aratus �$.50 ADDITIONS TO THE GENERAL FEES MULTIFAMILY DWELLINGS PER UNI 3 to 12 Units �$50 Per Unit Each Additional Unit � $25 OTHER ADDITIO Li htin Retrofit �$.25 r Fixlure Center Pivot Irri ation Boom �$40 Manufactured Home Park Lots � $25 Recreational Vehicle Park Sites � $5 Seuarate Bondina Insoection � $20 1 herebv cerWv that I Fce � total fee is S ecial Ins ection �$.31 er Mile �"� - /Z %� — v 5 � _ TNI_�N TS ALLATKlK�1AY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN_18 M HS '� � FOR OFFICE USE ONLY I IIIIII IIIII Iilli 1111! 11111IIIII Ilfll IIIII Illl illl ��� � F� A� � 3� i O 3 Z 2 O c Z� �� Request D te: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now ill Call a� You must call the inspector when readyl Date Ready: I cert'rfy that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecGon of the electrical work at: Job Address (Street, Box, or Route No ) CttY Z���%/ /� � p . � 7'� /f v� /(JC �/�l �L � ,s J Y Section Township Range Fire No. County ������ �,.,.,,,,,.� Phone Power Supp Electrical Co�tractor / Company Name /C.1 b���'/.�2.� �-c�'�c � Mailing Address (CoMrador, Company r Owner Performing �// c%� /U • %�L,� � or �nn E&00001A-13 ��r 58 � � Cont ctor License �j�O�l �stallation) ,�� s,� ing Installati n) BOARD OF ELECTAICT/ COPY -- s-��� ��3 z- License Number ?v:�• /!/1 �J �.S%� � Phone � ON B'GK OF YELLOW COPY /