P - 77167REQUEST FOR ELECTRICAL INSPECTION ��
1� 9 2.9 � p� H � Minnesota Board of Electricity �� ��
- � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 ,. �.
—�`� �''l�l�� (651)642-0800TTY/MRS1-800-627-3529www.electricity.state.mn.us �:��
Describe - sing the back of th hite copy if necessary - the woric covered by this request:
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere $25 Supplemental Fee $20
401 to 800 Amoere (� $50 Transformers uo to 10 KVA Ca? $10
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A paratus $.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit
Center Pivot Irrigation Boom �
Manufactured Home Park Lots
ONE 8 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
Additional Ins edion Tri s $20
Investiqative Fee
Reins ection Fee $20
TOTALFEE y�
(minimum total fee is $201 N i� S
I insoeded the electrical installation described herein on the dates stated: I
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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1929828�
Date: Rou h-in Ins ection Re uired?
�1 /� g p q ❑ Yes Inspedion Other Than Rough-In: ❑ Ready Now ill Call
� v��+`�� �v� You must cal� the inspector when ready! Date Ready:
I certify that I am the %CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site SVeet Address � City
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Township Section Range Fire No. County
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Owner/Occupant Nam � Please Provide Two (2) Phone Numbers Including Area Code
cc. eirLGSI� � '�3�S74- / a• ( )
Electrical Utility Electrical Utility Address
13562 EsMral Ave
:ont �n
763-757_-620,2
Master Electncian �or
License Number
Please Provide Two (2) Phone Numbers Including Area
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