P - 75825REQUEST FOR ELECTRICAL INSP.ECTIO�V
1����` � 12 5� Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
?�- `' (651)642-0800TTY/MRS 1-800-627-3529 www.eleciricity.stnte.mn.us
Describe -using the back of the w�hite copy ff rtecessary - the work covered by this �equest:
�i�slt (l ��rJ GL i�G�de� �'eG�(OIL� p�po��,
GENERAL FEES Outdoor Li hting Standard $1
SERVICES / POYdER SUPPLIES TraRc Signal Standard $5
0 to 400 Am re@$25 P Sup lemental Fee @$20
401 to 800 Am re$5D Transformers u to 10 KVA $10
Above 800 Am re$75 Transformers over 10 KVA $ 20
CI CUITS / FEEDERS Tiansfortner / Power I for SI / Outl'me Li htin $5
0 to 200 Am re$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above Z00 Am $10 Includ� the Service arid/or Power SupPty up to 500 Amperes, M
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellir�g Unit @$80
CIRCUffS, CIRCUITS OF LESS THAN 50 VOLTS Additianal Irrs 'on Tri $20
Each System Device or Ap ratus Q$.50 ImesGgative Fee
ADDITIONS TO THE GENERAL FEES Reins on Fee $20
MULTIFAMILY DWELLINGS PER UN TOTAL FEE �
3 ro 12 Units @$50 Per Unit (minimum total fee is $20) �J ,��
Boom
I hereby certify that I fnspected tl�e electrical hista➢eUon desafbed frereN on tlre detes eteted:
-0�I
Spedal I on @$.31 r Mile
THIS INSTALLATION MAY BE QRDERED DISCONNECTED IF NOT COAAPLETED WITHIN 12 MONTHS
Ft�R OfFICE USE ONLY
IIuI�WUllllllllll��lll�u�lllll��l� � � �
19341254 `����� ���
�' Rough-in Inapectlon Required? ❑ Yes o Inspection Ofher Than Rough-In: Ready Now ❑VYm CaA
' d�Q � You must c:aU the irrepector when readyl Date Ready: � 3'� �
I certify tfrat I am the CENSED CONTRACTOR ❑ COMPANY ❑ OWNER and herebylequesE i�spection of the ele.ctrical work at
�ob stce addr�s ° c�ty �
� � v� IV E �_ ��C
Townsh�P Secdon Range Fire No. Cou
� � �G
�vn O�aM NamO Ple� Provlde Tv� (2) hnrte N I�ludirtg Area Code
� �� �' le� � � ��' S�%�)
Name
ma�er Frecmaan or
License Number
��:.� iLti.�l�i'�it\Inl/'!f� �l �iI'I'FLI, %�1"/��'�/ll�����i r�
� 1._ .� ' �i ��.'�'.�. �� , � 1 �.� •
° • � . ����a� _ . .n..