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