P - 76221p REQUEST FOR ELECTRICAL INSPECTION
2�`1 � 7� O 9 3 � Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� �'" (651) 642-0800 TTYlMRS 1-500-627-3529 www.electricity.stote
D ;�-usi.r'�g the back of whfte copy'rf necessary - the work covered by this requ�st: �
����J C�SdYI �� �' ���]- � ��
GENERAL FEES Outdoor LigMing Standard @$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard @$5
0 to 400 Ampere @$25 Sup lemertlal Fee @$Z(1
401 to B00 Am re$50 Transformers u to 10 KVA $10
Ahave 800 Am�re na �75 Transformers over 10 KVA (6D $ 20
0 to 200 Am re $5
Above 200 Ampere @$10
RM, COMMUNICATION, REMOTE CONTROL, SIGNALII
:UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
.TIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Eadi AddiGonal Unit @ $25
OTHER ADDITIONAL FEES
Lightin Retrofit @ $.25 er Fixture
Cerder Pivot Im aation Boom �$40
Manufactured Home Park Lots $25
Recreadonal Vehicle Park Sitas $5
Se Bon ' Ir�s 'on $20
Special Ins on @$30 per Hour
Special I 'on @ $.31 r M7e
IS INSTALLATION MAY BE ORDERED
i�II II II� II II� li �II II �I II I II H III II III �� I I�
21678834
ONE & TWO FAMILY DWELLINGS, EACH UNR
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Txro Inspe�.fion Trips Each Dwelling Unit @$80
Additlanal Ins on Tri $ZO
Investigative Fee
Refns 'on Fee @ $20
TOTALFEE
(minimum total fee is $20) �
tws u�a Foa unrECroa ug anr
I hereby certfy tl�at I Nspected the elechical insfelladon descrihed herein on the dat� at�d:
�r
�MPLETED WITHIN 12 MONTHS
R��t'J�`� - 5 2007
�,�ti�l� C�I I�i�
�� ��� I o� Rough-in Inspectlon Required9 ❑ Yes �IVo Inspectlon Other Than Rough-In: 0 Ready (dow �Wip CaII
You must cell the inspector when readyl Date Ready:
I certiRy that I am the �.ICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby �uest inspection of the electrical work at