P - 76622�
REQUEST FOR ELECTRICAL INSPECTION - ��
I 2 rs 0���a g g 3� Minnesota Board of Electricity s� �„
C�� �� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �`
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back oithe white copy if necessary - the work covered by this request:
, e.\ � l�S �- �� � -'���5
GENERAL FEES Outdoor Lightin Standard @$1
SERVICES / POWER SUPPLIES Tra�c Si nal Standard $5
0 to 400 Ampere $25 Sup lemental Fee @$20
401 to 600 Am re $50 Transfortners u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $1 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Inspection Trios (�a $20
Each System Device or A aratus $.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irrigation Boom @ $40
Manufadured Home Park Lots C� $25
TOTAL FEE
total fee is $20)
I inspected the elecVical installation desaibed herein on the dates stated:
SeVarate Bondin ylns ^ionc, $20J 2—� ��
S el IOSpCCtiOn $30 pef HOU� E%PoREDIAfli11DON oA�
S ecial Ins ection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS ____ _
� --�-;- ����:�
�iilllllllllllllllllllllllllllllllllll��l �i ��- �� � -
� 0 8 0 9 9 3 5 �,�� ���} �� �
� �
�Date: Rough-in Inspection Required? ❑Yes o Inspection OtherThan Rough-In: ❑ Ready Now Will Call
1 1� �� V� You must call the inspector when ready! Date Ready:
I certify that I am the �`LICENSED CONTRACTOR p COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address �� �� �� Ci� ��
Township Section Range Fire No. County -
�'�� � �
ElecVi
Centerpoint En rg�
Anoka, MN 55304
o�
�r 6��'
Please Provide Two () Phane Numbers I
�� v� 3) S-1 1 • ��4�( )
Area
License Number Master Electrician or Power Limited Techni
G,�� � License Number
Please Provide Two (2) Phone Numbers Including Area Code
\ � \ /
1PVi ce nnnn.w .e ...