P - 77391�
REQUEST FOR ELECTRIC INSP CTI4 `�'�
���� 1- 3 3 2 0� Minnesota Board of Electricity ���—(' /�j�� ;ri- _
1821 University Avenue Suite S-128, S t innesota 5510
(651) 642-0800 TTY/MRS 1-800-627-3529 x�x�x�.electricitv.state.mn.us
DesCribe -using the back of the white copy if neGe&So'�[v.•the wwrk�d,by�is 49pupbt, ��� �.�.�H
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GENERALFEES_
SERVICES I POWER SUPPLIES
0 to 400 Ampere @ $25
401 to 800 Am ere $50
Above S00 Am ere $75
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
�ightin Retroft @ $.25 per Fixture
Center Pivot Irri ation Boom @$40
Manufactured Home Park Lots (� $25
Traffic Signal Standard
Supplemental Fee @ $
Transformers up to 10 I
Transformers over 10 h
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes lhe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investigative Fee
Reins ection Fee $20
TOTALFEE t
(minimum total fee is $20) �•�t�
THIS AREA FOR INSPECTOR USE ON�V
I hereby certify ihat I inspected the electrical installation described herein on the dates stated:
' � r/— 0!
Special Inspection $.31 er Mile
THIS INSTAI.LATION_MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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17813320
Rough-in Inspection Required? ❑ Yes �] No I Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
I certify that I am the �] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
�o:��t��[ �� _ _ ��trFRIL�LEY —
'�, Township Section �, Range II Fire No. I County
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���!'A�n�� ��J�� �'�{ � - Please Provide Two (2) Phone Numbers Including Area Code
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'I �WtE�PI°�� ��4y 7��fL �,�jtif'�J(S 1 � j[Jj�; ' Conhactor l��isa(�g j I Master Electrician or Power Limited Technician
i License Number
I M�lir� A dre s Contractor Company or Owner Performin Installation � �� -�� �� 1- -�
��4t� �(E�f��iIT�ifiIRL RGAD, S�l�NT F'A�1L, ht4� 5511�
Ayyprized ' e(Contractor or Owner Performing Installation) � i P�p:1�elProgipl,���?�S �h�ne Numbers Including Area Code
{I �OY�I` ' � ) ( )
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M}STRUITIONS ON BACKOF VELLOW COPY _ a[7aRn nF Fi Fr.rRinrv rncv �o ,..,,.,.,,, ,� e,..,,,,.