P - 76487REQUEST FOR ELECTRICAL INSPECTION '�
� � s � � �+�, � � � q, � Minnesota Board of Electricity �: � ��:
� � , 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �`
�" (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Descri using the back of the white copy�f n�gcessary - the work covered by is request:
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GENERAL FEES Outdoor Lightin Standard $t
0 to 400 Ar
401 to 800
Above 800
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 UNI
3 to 12 Units na $50 Per Unit
Center Pivot Irtigation Boom @
Manufactured Home Park Lots
5 ial Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED 1
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2 0 1 6 7 9 4 6
Traffic Si nal Standard �$5
Supplemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outiine Li htin $5
ONE 6 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweiling Unit @$80
TOTAL FEE /` /� /��
total fee is $201 +-�l l.J <� �./
I hereby certi(V that I inspected the elecVical inslallation desaibed herein on the dates stated: �
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exaneoiae�wooNeo on�
CTED IF NOT COMPLETED WITHIN 12 MONTHS ____
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O��� g pection Required? ❑ Yes ❑ No Inspec6on Other Than Rough-In: Ready Now ❑ Will Call
You must call the inspectar when ready! Date Ready:
I cerfrfy that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work ai
Job Site St t ��� �� Cft�t� ��
Township Section Range Fire No. Coun(y
Name
G
or (nmer Pertortning Installat
ne North P1
t
(?63) 78s-17(� (763 )
Master ElecVician or Power
License Number
-3300 � )