P - 76429p (� REQUEST FOR ELECTRICAL INSPECTION ���
1� O 2 l,� ����J � Minnesota Board of Electricity ��
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 ��
— r (651)642-OSOOTTY/MRS 1-800-627-3529 www.electricity.state.mn.us ����
�
De�scri��/, -usin the back of the white copy if necessary - the work covered by this request:
/-�2 ��G� ��.5� �O'}I �"�.-r%�J �r/q�.'�'�S
GENERAL FEES Outdoor Li hting Standard @$1
SERVICES I POWER SUPPLIES ,� Traffic Siqnal Standard (a� $5
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Am ere a$5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDiTIONS TO THE GENERAL FEES
MULTIFAMIIY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additionai Unit (�D $25
Irrigation Boom @
I Home Park Lots (
Vehicle Park Sites
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs / Outline Liqhtin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Inc�udes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTALFEE
total fee is $20) � � - ��
that I inspected the elecVical installation described herein on ihe dates stated: �
-1 7 � 7 �
INSTALLATION MAY BE �RDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
� �� . , �,s�_ J._� p '7
Illllllllllll�llln�llllllllllllllilllil��lll� -�,�., . 1.
1 8 2 0 4 2 D 6 ���'�`�,"���� ���/,�""
,"?-- 1
Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑ Ready Now ❑ Will Call
�� ��— � ou must call the inspedor when ready! Date Ready:
I certify that I am the ❑ LICEN ED CONTRACTOR ❑ COMPANY� OWNER and hereby request inspection of the electrical work at:
Job S' e Street Addresr� ' ���y
�`3 gt cafi�zAe Alr�f I'►/�{ lrnd'rx.�y
Township Sedion Range Fire No. County
�
Owner/Occupan� ame ��Z Pleas�Provide Two (2 Phone Numbe InGuding Area Code
D�'/�/�'G/C �.� (65� �36-���' (G�%)d5� 3��3
Electrical Utility E�ectrical Utildy Address
� �J L✓�.
Contractor / Company Name Contractor License Nun
Mailing Address (Contractor, Company or Owner Performing Installation)
Authorized Signature (Contractor or Owner Perfortning Installation) Please I
\ /
INSTRUCTIONS ON BACK OF VELLOW COPY ___ BOARD OF ELECTRICIN COPY
naascer tiecmaan or
License Number
Vumbers Including Area Code
\ �