P - 81987REQUEST FOR ELECTRICAL INSPECTION
�' % � Minnesota Board of Electricity = �
'' ���� 1- 5 6 3 �,�. 182i University Avenue Suite S-128, Saint Paul, Minnesota 55104
/ � (651) 642-QSQO TTY/MRS 1-800-627-3529
y ���' www.electricity.state.mn.us
Identity the work covered by this request:
❑ NEW REMODEL ❑ ADDITION ❑ REPAIR 1,� Q� c�� UC J�—� f�—Z ���
GENERAL FEES Outdoor Li htln Standard �$1
SEFiVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$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 Transiormer / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, Ali
ALARM. COMMUNICATION. REMOTE CONTROL. SIGNALING Circuits and Two Insoection Trios Each Dwelling Unit (� $80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL f
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Uni4 � $25
Manufactured Home Park Lots �
Recreational Vehicle Park Sites �
Fee
total fee is
the eledrical instellatiai des�xibed herein on
5oecial Insaection f� $.31 oer Mile � �/'i� �3 Gt� I
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF N07 COMPLETED WITHIN 1 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Olher Than Rough-In: ❑ Ready Now WIN Call
�'� l��� You must caN the inspector when ready! Date Ready:
I certity that I am the �,LICENSED CONTRACTOR ❑ CAMPANY ❑ OWNER and hereby request inspection of the eleclrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
��i o l�'-e.n►�e2�'ass � -�iri d (.-�; " 32�
Section Township Range Fire No. Courity
OccuPant _ C� )`F'i� ��l` i/ 1( R/,�� ' 1,� �r Ph [/^�'`� 1 �' Oq D V
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C� l.Y
13562 CENTRAI
Maiiing Addre ,
Authorized S' ture ( ntractor�
EB-OOOOtA-13 7/1/2000
�� ��C, CoMractor License Number Master license Number
N.e. D (�55�
er Performing Installation)
' / t .lation) Phone �"` l �� lY '^' !�
�� BOMD OF ELECTRIC[fY COPY INSTRUC710N3 ON BACK OF YELLOW COPY