P - 82529REQUEST FOR ELECTRICAL INSPECTION
1� ti � J- 9 3 6 �� ` Minnesota Board of Electricity
182t University Avenue Suite S-128, Saint Paul, Minnesota 55104
_ ��,�� (651) 642-0800 TTY/MRS 1-800-627-3529
www. e lectricity. state. mn. us
Identify the work cove�ed by t isSque�
-�n
❑ NEW ❑ REMODEL ❑ ADDITION EPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic 5i nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Amoere �$50 Transformers u to 10 KVA �$10
0 to 200 Ampere (� $5
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTR(
�UITS, CIRCUITS OF LESS THAN 50 VOL
Each System Device or Apparatus �$.50
ADDITIONS TO Tl1E GENERA
.TIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units f� $50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEf
Lighting Retrofit � $25 per Fixture
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
Separate Bond'mg Ir�spection � $20
Special Inspection � $30 per Hour
Special Insoection � $.31 cer Mile
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin (� $5
ONE & TWO fAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two In ion Trips Each Dwellin Unit �$8(
Additional Inspection Trips � $20
Investiqative Fee
I herebv certiiv that I insoecled tlie electrical instaqaGOn
tOt31 f28 IS
on
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-In: Ready Now � wll Call
11 3 00 You must call the inspector when ready! Date Ready: 1], 3� Q Q
I certiTy that I am the � LICENSED CON'fRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricai work at
Job Address (Street, Box, or Route No.) City Zp CoAe
125 ALDEN WAY FRIDLEY 55432
Occupant Phone
TOM KINGDOM 586-0788
Power Supplier Address
NSP NORTH DIVISION 3115 CENTRE POINT DRIVE ROSEVILLE MN 55113
Electrical Contractor / Company N9me� , � Contrec[or License Number Master License Number
TOTAL ELECTRIC, INC. CAO 2749
Maiting Adtlress (ConVactor, Company or Owner Performing Insfallation)
7/1/2000 � BOARD OF ELECTRICffY COPY INSTAUC710t� ON BACK OF YELLOW COPY