P - 80487� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electrici ``°�
���� 8� 3�� s� . 1821 University Avenue Suite S 28, SainY Paul, Minnesota 55104
• ���a (651) 642-0800 TTY/MRS 1-800-627-3529
' www.electricity.state.mn.us
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ADDITION ❑ REPAIR ' � � �� � � � � �� " °
GENERAL FEES Outdoor Li tin Standard C� $1
SERVICES / POWER SUPPLIES TraHic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am re �$50 Transformers u to 10 KVA '� $10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere � ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
AIARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ion Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addftional In ion Tri �$20
Each S tem Device os A aratus �$.50 lnvesti ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee (� $20
MULTIFAMILY DWELLINGS PER UNI TOTAL FE d�
3 to 12 Units (� $50 Per Unit (miltimUm tOt31 f28 iS $2
E2Ch Additi0�el Unit �$25 � i��p use aav
OTHER ADDITIONAL FEES j./N- ��• 3 r°�
Li htin Retrofrt �$25 er Fixture Jo `�� �a
CaMer Pivot Iri ation Bflom �$40
Manufactured Home Park Lots �$25 ' � nereb certity that I inspected u,e e�edrica� instal�aUOn described herein on ttre da�s sta�d:
Recreational Vehide Park Sftes �$5 fl010H1N DA7E
Se arate Bondin Ins 'on � $20
Soecial Insoection �$30 oer Hour FlWLLINSPECTION ' � w,�
FOR OFFICE USE ONLY
I{illll Illll IIlIR IIIII IIIII I!!II IIlII 14!l11�11IIII �Q�' ��
�4 1 1 6 B 3 O 5 9� 1� �D
Request Dete: Aough-in {nspection Required? ❑ Yes No inspection Other Than Fough-In: Ready Now Q WiN Catl
9�2 rj—� 1 You must call the inspector when ready! Date Ready:
I certity that I am the LICENSEO CONT CTQR ❑ COMPANY ❑ OWNER and hereby request inspection of the elechical work at
Job Address (Street, Box, or Route No.) � 4� City Zip Code
6535 Clover Place NE Fridle
Section Township Range Fre No. Counry
Occupant Phone
Wendell Olson 763-571-9379
Power Supplier Address
Elechical Co�trador / Company Name CoMractor license Number Master License Number
Tot 1 Elec ric Inc. CA02749
Mailing Address (Contractor, Company or Owner Performing Installation)
�(ature Cordracror, C a ner Pe �n In ation Phone
( P 9 )
/J � 763-786-8484
�nrl000 BOARD OF ELE m co n�rAUCrwHS a+ encK oF reuow coPr