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P - 79572REQUEST FOR ELECTRICAL INSPECTION w� �� Minnesota Board of Electricity - �- 2 5 2�� 0 O P�° 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 ,�� s�� (651) 642-OS00 TTY/MRS 1-800-627-3529 �� www.electricity.state.mn.us Identify the work covered by this request: �f ,>,!� A/`/�/�f �� /�►Q�� F"`��/�C"i �!�'�'`� /% ❑ NEW [,�REMODEL ❑ADDITION ❑ REPAIR 0 to 400 Am ere �$25 401 to 800 Am ere �$50 Above 800 Am ere � $75 CIRCUITS I FEEDERS 0 to 200 Am re �$5 Above 200 Am ere � $10 ALARM, COMMUNICATION, REMOTE CONTROL, SIG CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each stem Device or A aratus �$.50 ADDITIONS TO THE GENERAL FEES MULTIFAMILY DWELLINGS PER UNI 3 to 12 Units �$50 Per Unit Each Addftional Unit � $25 OTHER ADDITIONAL FEES Outdoor Li htin Standard � $1 Traffic Si nal Standard � $5 Su lemental Fee � $20 Transformers u to 10 KVA �$10 Transformers over 10 KVA � $20 Transformer / Power Su for Si ns I Outline Li htin �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service andlor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwellin Unit �$80 Additional Inscection Tri�s � $20 Fee � total fee is I herebvi ceNN Mat I insoecWd tl�e electrical insfallation described herein on the dates slated: I Recreational Vehicle Park SitA�t� ' fl01�"" �'� Se rate Bondin Ins 'on � $20 �25� S ial Ins ection C� $30 er Hour �"` "�CTON c� °"'� S ecial Ins ection �$.31 er Mile �� "`— � THIS INSTALLATION MAY BE ORDERED DISCONNECTED lF N COMPLETED WITHIN 18 MONTHS FOR OFFICE USE ONIY t �f�� I�� I��( /�t�� 1� 1�� i �� 1� ��}� �E 1 2 5 Z 3 O O 7�E %-L�-`��3 � � Request ate: Rough-in lnspectiort Req�ired? Yes ❑ No Inspection Ofher Than Rough-tn: ❑ Ready Now �il Catl �� (� "(,J You must call Me inspector whe re ! Date Ready: I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical waic ak Job Address (Street, Bo o Route No.) City Tap C � � �t''/ �1� ��30? � I iownsn�P � I aan� I Fire No. v y � i � �� Supplier � q � ntractor / ompan e ` Cor � / Address (Contractor, Company or Oxm Performing Installatlon) , � � �� Master License �aE�'G✓� G._. / LZL��i/ !/ t�i� c��.a'g� � �� BOAHD OF ELEC7AICf1Y COPY INSTpUCT10N3 ON BACK OF YELLOW COPY