P - 76546REQUEST FOR ELECTRICAL INSPECTION
1� 9 4� 3�3 �� � Minnesota Board of Electricity �-; ':
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 ., �:'
��-� S$�� (651) 642-0800 TTY/MRS 1-800-627-3529 www.e[ectricity.state.mn.us
Describe -us' the back of t white copy if necessary - the work covered by this request:
_lct , - �1 • � $gS
GENERAL FEES Outdoor Li hting Standard $1
SERVICES / POWER SUPPLIES Traffic Signal Standard $5
0 to 400 Am ere $25 Supplemental Fee @$20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUI7S / FEEDERS Transformer / Power Su I for Si ns I Outline Li hGn $5
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tn s $20
Each S stem Device or Apparatus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ction Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 Units @$5o Per unit (minimum total fee is $20) �'
Each Additional Unit @$25 *His na� Foa insrecroa use aar
OTHER ADDITIONAL FEES I
Lighting Retroffi @$25 per Fixture I hereby certify that I inspected the elecVical installation desaibed herein on the dates stated:
Center Pivot Irriqation Boom an $40 RWC"�" DATE
Se arateBondin Vlns � ionVV $20y �, - � -�
Special Inspection $3� �f HOUf E%PIREDIFd4NDON oA�
Special Inspection $.31 per Mile
THIS iNSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
� � - ti.� _ ..�_.
� ��� �� �� �� ��� �) � � �� � � �� ��� �� ��� �� ��� � ��� � ���� � — � �
1�9425859
�0� � � ��
°1 Rough-in Inspedion Required? ❑ Yes � No Inspection Other Than Rough-In: ❑ Ready No� Will Call I
j .Q„�(� /`
`N You must call the inspector when ready! Date Ready:
I certify that I am the� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Addr ��y
l ��j l.. T'� 1.�-' a �c+ �%� t` r' ���
Township Section Range Fire No. County �
Owner/OCCUpant Name
'� a �,. i � 1-�
Electrical Utility Electrical Utility
Centerpoint Ener y
Contractor / Cqn�l�n
� vvv..
qnoka� MN :i5304
Mailing Address (Cont erforming installat
1�1�s��.� o3oc� )
ense Number Master Electncian or P�
1--�i') �, License Number
��.)
Niease rro�tle Two (Z) Phone Numbers Including
\ / ` /