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P - 77361� REQUEST FOR ELECTRIC L INSPECTION -7 81- 3 3 4 6 _ y�� vr8�� ��.��-` '� 1V ❑ Minnesota Board of Electricit � 1821 University Avenue Suite S 128, Saint Paul, Minnesota 55104 �e -using the back of the wl GENI CES I POWER SUPPLIES fo 400 Ampere @ $25 )1 to 800 Ampere @ $50 bove 800 Ampere @ $75 ITSlFEEDERS to 200 Ampere Ca? $5 (651) 642-0800 TTY/MRS 1-800-627-3529 www.eleclrrcity.stute.mn.us copy if neceSSa[V.��e eintk,�WPded,by��teouest. S SW j f�H ttl,t �14GKU Vti'4 �L FEES Outdoor Lighting Standard @ $1 Traffic Signal Standard @ $5 Supplemental Fee @ $20 Transformers u to 10 KVA $10 Transformers over 10 KVA $ 20 Transformer I 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 ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20 Each System Device or Apparatus @$.50 Investigative Fee ADDITIONS TO THE GENERAL FEES Reinspection Fee @$20 TIFAMILY DWELLINGS 3 to 12 Units @$50 Per Each Additional Unit @ ; Retrofit @ �.25 per Fixture 'ivot Irriaation Boom (c� $4( I hereby certify ihat I i�iA�ret Zd.✓��i total fee is $20) the elecirical installation descnbed herein on ihe dates stated: -�� Special Ins ction @$.31 per Mile THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS __ II I�) (� III n III II III I) tll I�Ili IIIIIIII�III� NNI 1 7 8 L 3 3 4 6 � ��ii � I U� I Rough-in Inspection Required? ❑ Yes �] No �i, Inspection Other Than Rough-In: [�Ready Now L� Will Call '�� 1 You musl call Ihe inspector when ready! �! Date Ready: I certify that I am the 'L�I LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: '���'���.�*�#I�� ST hEE - ----- �,c�vFRTI?LEY Range NEf�GY \ / County (2) Phone Numbers Including \ / ���Q���G COF�F'O�{ATION '�Con�ractor�se�ll��� MasterElectricianorPowerLimitedTechnician License Number 'ess Contractor Company or Owner Performin Installation) �� TE�F:F;IT�IRIAL �;OAL�, 5�11�hIT f'AUL, MN 5�,11� — - -- - ---- ' t (ConUactor or Owner Performmg�lnstallation) ���pa�e�Pro�i����F�h�ne � mbers Including Area Code I i � � �