P - 76398REQUEST FOR EL,ECTRICAL INSPECTION
I�� 8 2 l, � 2: 1 Minnesota Board of Elec�ricity �
,,n ��, 182f University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -usirg Uie badc of the white copy'rf necessary - the work covered by ihis request:
�n s}�l l�v bre.-k.s b a,o ¢ c,<<..:.�s -cQ �Q �-e �� p fs.�. iti �; .. brv..�.e,.tay rt.n. oQ.�.�
GENERAL FEES Outdoor ' hti Standard $t
SERVICES I POWER SUPPLIES . ,r Tra�c Sipnal Standard (4 $5
401 to
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
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Irupection Trips Each DWreiling Unit @ S80
CIRCUITS, CIRCUITS OF LESS THAN 50 YOLTS Additional I ' T' $20
Each S m Device or aratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ' Fee a20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units @$50 Per Unit (minimum total fee is $20) �• "�
E3ChAdd'Itl01121Uf1it�S25 _%�� nasu�nFacw�cmnusEOenr
OTHER ADDITIONAL FEES � ) �7
' ti ReVOfit $.25 Focture I hereby cerMy tl� I inspeded the electriral ir�lallaUon desaibed herein anlhe B start60' [
Cer�ter Pivot I' ' Boom $40 ft01�"'" 0A7E
Manufaaured Home Park Lols s2s ��..� o 7
Reaeati�onal Vehide Park Sites S5 F""` �T10N /' 0A7E
Separate Bonding Inspecfion �$20 ( � S^ � C�
_ � THIS INSTALLATION MAY BE ORDERED
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�� Rough-in Inspection Requlred? Yes ❑ No Inspedion Other Than Rough-In: ❑ Ready Now �yNill CaN
Zl � l O� You must call the inspector when readyl Date Ready:
t certity that 1 am the ❑ LICENSED CONTRACTOR ❑ COMPANY OWNER and hereby request inspedion of the electrical wak at
Jab Si[e Street Address �� —: 7a - 3 c o
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Tovmship Section Range Fire No. County
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OwnedOccupeM Name Please Provide Two (2) Phone Numbers Induding Area Code
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Master Electrician or
License Number
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1CK OF BOAR� OF ELECTRIGTV CnPV
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The folloMring ftems are deviations from the acceptad stsndands of construcdon at the above descrfbed
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premi�s. Numbers after each item are appUceble Nadonal Electricat Code SecUons:
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�e�h. no�d d.nci�ncbs and: " `'
; LT i�o�t�r Insp�cior tor nimp�ctfex� bNbn cov�rinp wirin�.
� R�-Msp�ction will bs mad� at tirn� of r»xt fnsp�ction. �
��, GI'$f�n �nd r�tum this torm to Insp�ctor whsn cornotfona haw bNn n�eN but no la�
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� Signature of Installer
�' �obert ClausDr� �
15$6 E, Sextant Ave. oate of compuence .t��. !.. 4'`7
�� � �►ood, MN 55109 �
Call 651-777-7885 for ReinspecNo� - 7:00 - 8:30 a.m:
""'`' Monday - Friday except holidays.