P - 77591REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity " � � �
�347 368
• 1821 University Avenue Suke S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electrici ry. state. mn. us
Identify the work covered by this request:
❑ NEW ❑ REMODEL �ADDITION ❑ REPAIR �d � /k��v� - O �
GENERAL FEES Outdoor Li tin Standard �$t
SEHVICES / POWER SUPPLIES Tra(fic 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 re �$75 Transformers over 10 KVA � S20
CIRCUITS / FEEDERS Transformer / Power Su for ' ns / Outline ' hti � S5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re�$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspectlon Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additio�al I ion Tri s�$20
Each S em Device or ratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Rein 'on Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Hnits �$5o Per Unit (minimum total fee is $20) J, �
Each Additional Unit �$25 F0" "'�"`�f0" "� 0N1Y
OTHER ADDITIONAL FEES
Li hli Retrofit �$25 r Fixture
Cerner Pivot I' atbn Boom �$40
Manufactured Home Park Lots � 325 I hereby ce' that I inspected the electrical installation desaibed herein on the detes stated:
Recreational Vehide Park Sites �$5 P016H1N t� o"'�
Se rate Bondin In � $20 /<--31 �
S' I� ' n U$30 � Hou� rinu �cna+ � � unh ✓
S ial In 'on �$.31 r Mile f 3 I��� — Z-�c'�T�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETE WITHIN 18 MONTHS
�R OFFlCE USE ONLY . _, /'ifn '1
I ceAi(y that I am tlte ❑ LICENSED CONTfiACTOR ❑ COMPANY
Jon Ad�s (street. 9ox, a Houte Wo.) cily
18� � t,J �e..�
Sectlon Township R ge Rre Pk
�� ��f
vw �n
� �. • � j,�, �,.�
� s��� naarees
� �..- - ��#�C.
Eleatriral Contracoor / Coprpep�:D�9iqe'.` : ' � q
� �3 �3 �. i�
A4dlrg /►dd�ss (Contretxor. Compary or owrler Perlomirq xnmN�on)
�:�
ArMoAud :( � Campan w Ormer Patkrmkp Iro�o
�9090fA-13 �. 7/1f�DQD. . . .. . . ... . _ . ,_. :.�d
ER �d hereby requeat inepecbon ot the electrical wak at �: i
Zip Cade
�. 55�3�- �
co�rny �
�N��� .�
7 . ���� _� -� :�� �i �� �.�.��i i ��.
� �r �
i�
�l1.T 1�t =l��
� �,N�r�x Me� �,�ow�s. �Mmbs�
.,- , _. y
.�';�.
� ;
�tO�"' � �✓ V[ t
',.
'�_, �. � ..a ,<.-.. . ;.... _: ��10Ml.ON�¢AqC OFIiRA�.OW 'fAPY'- �