P - 77438REQUEST FOR ELECTRIC'pr�I INSPECTION
I ���� 9 21 Minnesota Board of Electricity �,(�d�_
� � � 1821 University Avenue SuRe S-128, Sain� Paul, inne �
(651) 642-0800 TTYIMRS 1-800-627-3529 www.elec .lt
Descri using the back th white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li hting Standard @$1
SERVICES / POWER SUPPLIES Traffic Siqnal Standard C� $5
0 to 400 Ai
401 to 800
Above 800
CIRCUITS I FEE
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit (� $25
Center Pivot Irrigation Boom �
Manufactured Home Park Lots
Recreational Vehicle Park Site:
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Transformer / Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ion Tri s $20
Investi ative Fee
Reins ection fee $20
TOTAL FEE
(minimum total fee is $20) d "
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I hereby certify that I inspected ihe elecUical insWllation described herein on Ne dates stated:
S ial Inspection $.31 per Mile /'�� "'✓
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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18879213
uate: Rough-in Inspection Required? ❑Yes �}No Inspection OtherThan Rough-In: ❑ Ready No�Will Call
��� p� � v� You must call the inspector when ready! Date Ready:
I certiTy that I am the �,LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site SVeet Address City
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Tow ship Section Ranae Fire No. Countv _
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'rovitle Two (2) Phone Numbers Including Area
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� Centerpoint Ener y
Contractor / C et1 �a V. Contrador License Number Master ElecUician or Power Limited Technician
Anoka, MN 55304 /` i1 License Number
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Mailing Address (Contr erforming Installation)
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Author' ignatur Con � or o erforming Insta ion) Please Provide Two (2) Phone Numbers including Area Code
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INSTRUCTIONS ON BACK OF VELLO -0PV ARD OF ELECTRICITY COPY FR-nnnnia-t5 a i �nm