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P - 78769REQUEST FOR ELECTRICAL INSPECTION 1 4 81 �� J O � Minnesota Board of Electricity - 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651)642-0800 TlY/MRS 1-800-627-3529 www.electricity.state.mn.us NEW ❑ REMODEL ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request: GENERAL FE Outdoor Li htin Standard $1 SERVICES I POWER SUPPLIES Traffic Si nal Standard $5 0 to 400 Am re $25 Su lemental Fee $20 401 to 800 Am re E50 Transformers u to 10 KVA $10 Above 800 Am re$75 Transformers over 10 KVA $ 20 CIRCUITS / FEEDERS Transfortner I Power Su for Si ns I OuUine Li htin $5 0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All AIARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Grcuits and Two Inspection Trips Each Dwelling Unit @$80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri $20 Exh S stem Device or A atus E.50 Inves � a6ve Fee ADDITIONS TO THE �ENERAL FEES ReinsDection Fee �$20 � - 3 to 12 Units �$50 Per Unit Each Additional Unit � $25 I lul ll � ll lli 11111 ll lll {I IIi II III II �I ��I I Nll 1 4 8 1 8 9 0 0 TOTALFEE (minimum total fee is $20) TMS RREA Fp21N5PECi0R USE ONLV I hweby cer6ry that I i instaNa6on desaibed � ��� � z�� .cz-.. '�� ..�....)s.�v'<" . . �03g�' �° �g �� ��t �: Rough-in Inspection Required? ❑ No Inspectlon Other Than Rough-In: ❑Ready Now I Call / r 3 You muSt Cell �he inspectOt when readyl Da� R¢edy: I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby �equest inspection of the electrical work at: Job site nddress (S�L 6ox, a Route Wo.) CiIY ZP d�S ��.,o�,�%,e /�� �,o�y ��,3� 3� � v, � � nDany or D�lJ— Please Provide rwo (2) PFwne Mxnber(s) �naumng nn � ( 3 7,�-�7�?--� ,�� � �t T� •� Contractor ticense Number Master EJec6ician a Power ' ited' `'W�/�/_ �7 Lic�se Number �Lf/ � m) l �.1 T � � �'aD�3 �� aF r�rr eonRO oF �crnicm coPV E&00001A-14 e:�. soa�z