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P - 79591REQUEST FOR ELECTRICAL INSPECTION � � � � � � � � � Minnesota Board of Electricity � � � �' 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 ����� , �,,• �� (651) 642-0800 TTY/MRS 1-800-627-3529 ;.� ...� www.electricity.state.mn.us Identity the work covered by this request: ❑NEW ❑REMODEL ❑ADDITION ❑REPAIR ��—L'(,,L I �CLrI QSb%� (C VP.✓I,n.�u,� �D7'L �'�" � �(1 YPL GENERAL FEES Outdoor Li htin Standard �$1 SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5 0 to 400 Am ere �$25 Su lemental Fee �$20 401 to S00 Am ere �$50 Transformers u to 10 KVA �$10 Above 800 Ampere �$75 Transformers over 10 KVA �$20 CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5 0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Above 200 Am re �$10 Includes the Service ancVor Power Supply up to 500 Amperes, All ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelli Unit �$80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20 Each S siem Device or A aratus �$.50 Investi ative Fee ADDITIONS TO THE GENERAL FEES Reins ction Fee �$20 MULTIFAMILY DWELLINGS PER UNI TOTAL FEE � 3 to 12 Units �$5o Per Unit (minimum total fee is $20) Each Additional Unit �$25 wR INSPECTOR USE ONLY OTHER ADDITIONAL FEES Manufactured Home Park Lots �$25 I hereb ce ' that I inspected the electrical installatbn desa�ed herein on the tlates slated: � � Special Inspection �$30 per Hour _ I I"'"" "�' `"""�� � Sn�ial Insoection �$ 31 oef Mil@ � � ���^ � THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS —� FOR OFFICE USE ONLY I lillll IIIII lllli HIII Illll Illll NIIClfill li111111 �E 1 2 3 c 6 3 4 4�4 �'�O�O�� o�•S'(i Request Date: Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-tn: ❑ Ready Now i�l Call � You must call the inspector when ready! Date Ready: I cerfify that I am the �LICENSED CONTRACTOR ❑ COM and hereby request inspection of the e�ectrical work at: Job Address (Stree Box, or Route No.) �ity ZiP �ode I � �-i'YIDu'l tYG tG�,� Section Townshio Ranna Fc.a � r.,,��.,n, vwupam Phone p r��a ���� . 11 l�03'��7�1-' c� � % Power Suonlier e,� .e� � i (Contractor, Compan or Owner Performing Installation) .,..-....... , ?5 _ T n _ , License Number � Master License Number L-__L.�-, l�, " I� L(p'S"' L�i -�-��� � ES-00001A-13� 7/7/2 BppRp OF ELECTRICITY COPY INSTRUC710NS ON BACK OF YELLOW COPY