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P - 82020REQUEST FOR ELECTRICAL INSPECTION Minnesota Board of Electricity � 1-15 0- 6 5 8 ��� �821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-OS00 TTY/MRS 1-800-627- www.electricity.state.mn.us � � '' ' Identity the wark covered by this request: ❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR C� GENERAL FEES Outdoor Li htin Standard �$1 SERVICES / POWER SUPPLIES Treffic Si nal Standard �$5 CIRCUITS / FEEDERS 0 to 200 Am ere �$5 Above 200 Am ere � $10 ALARM, COMMUNICATION, REMOTE CONTROL, CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each S stem Device or aratus �$.50 ADDITIONS TO THE GENERAL F Each Addftional Unit � $25 OTHER ADDITIONAL FEES Liahtina Retrofit � $25 oer Fi�ure Sup lemental Fee � $20 „ Transformers u to 10 KVA �$10 Transiormers over 10 KVA � $20 Transiortner I Power Su for Si ns i OulVine Li Min �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwellin Unit �$8C Addftional Insoection Trios � $20 I herebv certfv that I Fee � (minimum total fee is • ��9�1 fhe electrical installation described herein � S ial Ins �on �$30 er Hour "'""` "�'""' "" Special Inspection � $.31 per Mib `O " ��� �'� _ THIS INSTALLATION MAY BE ORDERED DISCONNECTED NOT COMPLETED WITHIN 18 MONl'HS Fon o� use o�x.r � ��i��i �ii�� ����i i���� i�iN� � � �- ���s • I�Illfilllllllll �- ���� o e s s s� a0.5 d ��� t3 .� Request Date: O/ Rough-in Inspedion Required? ❑ Yes ❑ No Inspection Other Than Rough-In: eady Now ��II Cal1 You must call the inspector when readyl Date Ready: I ceriity that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: Job Address (Street, x, or Route No ) Zp � ��l - t ss-�.3a Section Township . Range Fire No. Coun ^ . IOccupant � Electrical COntractOr � pEPENDABL C�on Rapids. tC. INCa or Cir�mer Performing Installatlon) OJ Phone 'iu�� - ...��•��, •••,���ra��y �� v..� renvrmmg insrananonl Phone � �� �., ,���z 7( 3-7s� s'l�p� &00001A 13 /1/200p gpApD pF FLEC7plpTy (,bip�r �CTpNg pN gpCK OF YELLOW COPY