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P - 78719REQUEST FOR ELECTRICAL INSPECTION 1 3 4 7 3 0 6 eg Minnesota Board of Electricity � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-800-627-3529 ' www.electricity.state.mn.us Identity the work covered by this request: ` A y� � d o /' � t /Uii ❑ NEW REMODEL ❑ ADDITION ❑ REPAIR L� w"�^, ��° t •� v GENERAL FEES Outdoor Li htin Standard �$1 SERVICES / POWER SUPPLIES Tratfic Si nal Standard �$5 0 to 400 Am ere �$25 Su lemental Fee �$20 401 to 800 Am re �$50 Transfortners u to 10 KVA �$10 Above 800 Am e�$75 Transfortners over 10 KVA �$20 CIRCUITS / FEEDERS Transfortner / Power Su for Si ns I Outline Li Min �$5 0 to 200 Am re �$5 ID ONE � TWO FAMILY DWELLINGS, EACH UNIT Above 200 Am re�$10 Includes the Service andlor Power Supply up to 500 Amperes, All ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two In 'on Tri Each Dwelli Unit �$80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins bn Tri s�$20 Each S stem Device or ratus �$.50 Investi ative Fee AoDITIONS TO THE GENERAL FEES Reins ection Fee �$20 ____ '�� Units � $50 Per Unit dditional Unit � $25 OTHER ADDITIOP � Retrofit � $25 per Fixture Pivot Irtiaation Boom � $4( Park Lots � Park Sites � soectian � $� t IrerebY cerMy that I total fee is installation described herein on the tleoe � - c,�'s --� �:.� g :T = � �� ^ FOR OFFICE USE ONLY fl�Ill��IIIIiIIlII111�II�IIIIIIINilllllllllllilll � /�,�6� �E 1 3 4 7 3 O 6 1 3E '" '��'s� Request Date: Rough-in Inspection Required? Yes ❑ No Inspection O[her Than Rougfrin: ❑ Ready Now �� Cal� —�� �/ You musi call the inspector when ready! Date Ready: � I cerMy that i am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecUical work at: .bb Address (Street, Box, or Route No.) r CdY�j�/ Zi�� � � Z � Section Township Range Flre N� Counry � �O � P� /1 '/ Phone OCCU/ !-r JM IW / l..i� � / /N/! � � `� . �/ � i P�a� rector / Compj ny Name �� Contractor License -s Cl�cf �% 4 ��t�fi�� 1.�- �33d. �s (Conhactor, Company or Owner Perfortm IlatQn) � �Z 3 rQ�-c. ��s�t/n�x� r �nature (Contractor, Com y o Owner PeAorming Installation) �� ���� ����Zppp BOARD OF ELECTRICRY COPY vr�l� � Master License Number 55 ���� I INSTAUCTIONS ON BACK OF YELLOW COPY