P - 76246REQUEST FOR ELECTRICAL INSPECTION '°'•�
q��� 4� o o� � Minnesota Board of ElecVicity -
Je 1821 University Avenue Suite S-929, Saint Paul, Minnesota 55104
�- —"" ` . ,�651) 642-0800 TTY/MRS 1-500-627-3529 www.electricity.state.mn.us ` �" "�
D�aibe -using the back of the white copy 'rf necessary - the work covered by this request:
GENERAL FEES Outdoor Lighting Standard @$1
ERVICES / POWER SUPPLIES TraHic Sigmal Standard @$5
0 to 400 Ampere @$25 �. Su temental Fea @$20
401 to BDO Am re $50 Transformers u to 10 KVA $10
Above 800 Ampere @ 575 Transformers over 10 KVA $ 20
C CUITS I FEEDERS Transfortner I Power Su I for Si ns / Outlirre Li htin $5
0 to 200 Am re $5 �. �' � ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes tha Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits artd Two Inspection Trips Each Dwe�ing Untt @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 'on Tri $20
Each S tem Device or A paratus @$.50 Investigative Fee
ADDf110NS TO THE GENERAL FEES Reins ection Fee $20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units @$50 Per Unit (minimum total fee is $20) �
EaCh AdditiOnal Unit @$25 "°S""E" F°R °vs°ECr°" us� °^°''
OTHER ADDITIONAL FEES
Li hting Retroffi @$25 per Rxture I hereby cerlify that I inspected the elecVical instaVaBon described here6i on the daeas stated:
Center Pivot IrrigaUon Boom @ $40 � f� �A�
Manufactur� Home Park Lots $25 � �'�"'��/1(!� � �f
Recreational Vehicle Park Sites $5 �°'�070N � °ATE
Se arate Bondin Ins 'on $20 r� ��
Special Ins 'on @ $30 per Hour °�0/ °ATE
S ' Ins 'on @ $.31 per Mle
THIS INSTALWTION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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lS/ You must call the inspector when readyl Da[e Ready.
I certify that I am the LICENSED COMRACTOR ❑ COMPANY ❑ OWNER arM hereby request inspection of the e�ectrical work at
Job��e� ddress — � � 1`, c� �., � � � ��(Y
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Township SecUon Range Fire No. CouMy
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OwneNOccupant Neme Please Provide Two (2) Phone Numbers Including Area Code
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Electrical Utiiity Elecfical Utility Address
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�Co d�ora / C%�� N e �! `,�' Contrador License Number Mas[er Eledricfan or Power Limited Technicaan
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Mai�Address�Co� dor,�mPe a� �����"^+ ��� '�LJ a V'� ,f��/ cJ���
utho SlgnaWre (Coriha or Owne erfortning Installation) Please Provide Two (2)�one u rs Including Area Code
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3 TIONS ON BA O YELLOW CQPY BOARD OF ELECTRICITY COPY EB-00001A-15 8.1. 2004