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P - 76375REQUEST FOR ELECTRICAL INSPECTION ���`�`�'k , 2� 0 2 4� 516 � Minnesota Board of Electricity <� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 C,�a (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us !�� Desc ' ing the b�k-of th hi e copy if necessary - the work covered by this request: � '�' :�0 � - '1'1- �S G L FEES Outdoor Li hting Standard @$1 SERVICES I POWER SUPPLIES Traffic Si nal Standard $5 0 to 400 Amoere a(� $25 _ Supplemental Fee @$20 Above 200 Am ere a$10 ALARM, COMMUNICATION, REMOTE CONTROL CIRCUITS, CIRCUITS Of LESS THAN 50 VOLTS Each Svstem Device or Aooaratus an $.50 3 to 12 Units @$50 Per Unit Each Additional Unit @ $25 OTHER ADDITIO Liqhtinq Retrofit (a2 $.25 per Fi#ure Special Inspection a$30 per Hour Special Inspection $.31 r Mile THIS INSTALLATION MAY BE ORDERED [ I IIII II III I I��I I I III II � �� II II I II III II III ��I I�I ? 0 2 4 5 1 6 3 Transformers u to 10 KVA $10 Transformers over 10 KVA @$ 20 Transformer I Power Supply for Signs I Outline Lighting @$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit @$80 Fee TOTAL FEE h 5U total fee is $20) ,�1�� I hereby certify that I inspeded Me elechical inslalla6on described herein on the dates stated: 0 ONNECTED IF NOT COMPLETED WITHIN 12 MONTHS__�_ __� � �� 1 � �� � �����► ��.�; C,� ° _ . Date: Rough-in Inspection Required? ❑ Yes �fJo Inspedion 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 te Street Address City �U � ��d Township Section Range Fire No. Coun • Y�O��. �er/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code �� � � � � /.� �O� fiv� StS(o' ��J ) Electncal Utility - Elec Centerpoint Ene g) Contrador / Cor�9�8 en � Anoka, MN 55304 mascer eiecmcian or License Number or ai n) Niease Nrowae i wo (z) Nhone rvumbers i � � \ �