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P - 77048REQUEST FOR ELECTRI L INSPECT O,�I `� � Minnesota Board of Electricity �� ����5, �� `� �� 1� 8 8�- g g 6 0 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �� (651)642-0800TTYlMRS1-800-627-3529wx�w.electriciry.state.mn.us �a�� Describe -using the back of the white copy if necessary - the work covered by this request: �� '� GENE L'FEES Outdoor Lighting Standard @$1 SERVICES I POWER SUPPLIES Traffic Si nal Standard $5 0 to 400 Amoere C� $25 Supplemental Fee (a� $20 ALARM, COMMUNICATION, REMOTE CONTROL, SIGi CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device or Apparatus @$.50 ADDITIONS TO THE GENERAL FEES MULTIFAMILY DWELLINGS PER UNIT 3 to 12 Units an $50 Per Unit Transformers u to 10 KVA $10 Transformers over 10 KVA @$ 20 Transformer I Power Supply for Signs / Outline Lighting @$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service andlor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit @$80 TOTALFEE �r- ` total fee is $20) ;JcL> `�9 I herebv certiry that I inspeded the eledrical installation described herein on the dates stated: � Center Pivot Irri ation Boom $40 "°°""'" �"" Manufactured Home Park Lots $25 Recreational Vehicle Park Sftes $5 F��� �NSPecT�or� oATe Se arate Bondin Ins ion $20 �-t��� �� %' G Speciallnspection $30p2fH0Uf exaiaEOinsnr+ooneo onTe Special Inspection $.31 per Mile THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS �� ��� � . I IIII !. I�I il lil I� ��I II III I III II III II III u� .,� 1885896� Date: Rough-in Inspection Required? ❑ Yes �Jo Inspection Other Than Rough-In: ❑ Ready Now�Will Call / � ��� ���' (�L� � 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: Range � �on[rac2or i o n rv me �oi - �E�C��IC GCVIC�S � Mailing Addres (� t Y r, o y � r P in ��t� �ion) Fire No. County \ F� Y°��C�, Please Provide Two (2) Phone Numbers Including Area Code \ / \ / ise Number Master Electrician or Power Limited Techni� � � License Number PIea�P�ovide Two (2) Phone yymbers Including Area Code