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P - 77425REQUEST FOR ELECTRICAL IN PE�TION ���'�'� 10 $� 2� 5 8 7 � Minnesota Board of Electricity O� QQ� ` y k, � 1821 University Avenue Suite S-128, Saint Paul, Minneso�65��4 �"� (651) 642-0800 TTY/MRS 1-500-627-3529 www.electriciry.state.mn.us �� Describe -using the back of the white wpy iCf necessary - the work covered by this request: ('� / O li�� J��/1v\ aK�'�.TFd aI\�� ��/J6."'� �i 1/W—� GENERAL FEES Outdoor Lighting Standard @$1 SERVICES I POWER SUPPIIES Traffic Si nal Standard $5 0 to 400 Ampere $25 Supplemental ee $20 401 to 800 Am re $50 Transfortners u to 10 KVA $10 Above 80�Ampere $75 Transformers over 10 KVA (� $ 20 CIRCUITS I FEEDERS 0 to 200 Am re $5 Above 200 Ampere $10 ALARM, COMMUNICATION, REMOTE CANTROL, CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each S stem Device or Apparatus $.50 ADDITIONS TO THE GENERAL F MULTIFAMILY DWELLINGS PER UNIT 3 to 12 Units @$50 Per Unit Each Addi6onal Unit (o� $25 Home Park Lots � 'ehicle Park Sites THIS INSTALLATION MAY BE ORDERED 1 I(III II I� �I II) (I III II III II III II III II II) �� (UII �,81,�5872 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT Includes the Service andlor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit @$80 Additional Inspection Trips @ $20 Investigative Fee Reinspection Fee an $20 total fee is I hereby ceAity that I inspeded the eledrical installation described herein on the dales stated: � IF NOT 12 MONTHS /��// �1n1K'3- QRough-in Inspection Required? ❑Yes �Io Inspection Other Than Rough-In:�eady Now �Will Call _ 1 � ` � 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 Sit� �i�� �0�� ��l P� �n n` c� ri � o,� Name Harrison .1 , . ractor, Company or Owner Perfor 3440 Kilmer L r (Contractor or Owner Perfortninc �2) License Number I Master Electrician or Power License Number (2) Phone Numbers � \ / ���