P - 775831� O c A s�� c � REQUEST FOR ELECTRICAL INSPECTION ����
0 U 0 U� Minnesota Board of Electricity k �
(/I,,�j'` 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �`
v [ L l (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �,�s�
Describe -using th2 back of the whfte copy if necessary - the work covered by this request: OD C�D����
' � �c�n 65�-7�7- �FsS�'S e�
GENERAL FEES Outdoor Lighting Standard $1
SERVICES I POWER SUPPLIES Traffic Siqnal Standard (�a $5
0 to 400 Ampere a$25
401 to 800 Am ere $50
Above 800 Am re $75
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SI�NALING
CIRCUITS, C�RCUITS OF LESS THAN SO VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL
Liqhtinq Retrofit Cd $.25 per Fixture
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliing Unit @$80
Additional Inspection Trips @ $20
� Investiaative Fee
.
total fee is $20) . S �
I insoected the elecUical inslallation descnbed herein on the dates stated:
�tion $30 per Hour `^"'"`°'""""`"'"`" — ""
�tion @ $.31 per Mile
,LATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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InI n(I� (I I�I II �I� (I II) �I I�I II III II ��I �� I��
18687962
Date: Rough-in Inspection Required? ❑ Yes �No Inspection Other Than Rough-In: ❑ Ready Now O Will Call
�/ ��� You must call the inspector when ready! Date Ready:
I cerfrfy that I am the�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address Cdy
13 7 i�G/��►Gin Ci/'t�. t-/ %Cf?�,!
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` M1cTRI1CTIONS ON HACK OF YELLOW
f�3 ) s�i —1� i )
Contrador license Number Master Electncian or Power Limdetl Technlcian
� ����� License Number
)
Please Provide Two (2) Phone Numbers InGuding Area Code
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ELECTRICITYCOPV EB-00001A-15_, 8_1,2069 .