P - 76596REQUEST FOR ELECTRICAL INSPECTION �����
1 � 8 � � :�a � � 2 � Minnesota Board of Electricity �- ,,,f:'��„
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
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��'1� (651)642-0800TTYIMRSI-800-627-3529www.e/ectricity.state.mn.us !��
Describe -using the back of the white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Lightin Standard $1
SERVICES / POWER SUPPLIES Traffic Siqnal Standard la� $5
0 ta 400 Ampere a$25
401 to 800 Am re $50
Above 800 Am ere $75
CIRCUITS I FEEDERS
0 to 200 Am re $5 — V�f
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Ap aratus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit C� $25
nter Pivot Irri ation Boom $40
inufactured Home Park Lots a$25
creational Vehicle Park Sites $5
arate Bondin Ins ection $20
ecial Inspection $30 r Hour
ecial Ins ection $.31 er Mile
INSTALLATION MAY BE ORDERED
IIII II III (I III II III II (II II III I� II) I) II� �� (�
1 8 4 2 1 3 2 L
Transformers over 10 KVA $ 20
Transformer I Power Supply for Signs I Outline Lighting @$5
ONE 8 TWO fAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Insoection Trios l�D $20
TOTALFEE
total fee is $20) ��.%
I hereby certify that I inspeded the elecirical inslallaGon described herein on the dates stated: �
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WITHIN 12 MONTHS
✓� oo� ' �O �D�
Date: Rou h-in Ins ection R uired?
� V^ _ G� 9 P eq ❑ Yes o Inspection Other Than Rough-In: ❑ Ready Now ill Call
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� You must call the inspector when ready! Date Ready:
I certify that I am the�CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site SVeet Addre ��y
�to C� �� c��- �...�.v�.� r � � �
Township Section Range � Fire No. County . _ � i�
e �n�w�o
Electrical U'li y EI
Centetpoint En r
Contractor / Comp� e �
Anoka, MN 553�
Mailing Address (Contract i
Authorized Sjg�/ ore (C recto O � e in�,
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INSTRUCTIONS ON BACK OF YELLOW CO
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OF ELECTRIC�TY COPV
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:r Master Eledrician or
/ License Number
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Jumbers InGuding Area Code
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