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P - 77310REQUEST FOR ELECTRICAL INSPECTION y���'���� 1����� 14 3 2 Minnesota Board of Electricity � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 `����� �' (651) 642-0800 TTYIMRS 1-800-627-3529 wH�x�.elec�ricity.state.mn.us '�;� Describe -using the back of the white copy if necessary - the work covered by this reques . �fJ:�`v /` GENERAL FEES Outdoor Li htin Standard $1 SERVICES I POWER SUPPLIES Traffic Sianal Standard (a� $5 Above 200 Am ere a$10 ALARM, COMMUNICATION, REMOTE CANTROL, CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each S stem Device or Apparatus $.50 ADDITIONS TO THE GENERAL F MULTIFAMILY DWELLINGS PER UNIT 3 to 12 Units @$50 Per Unit Each Additional Unit @ $25 OTHER ADDITIONAL FEES Li htin Retrofit $25 per Fixture Center Pivot Irriaation Boom na $40 Supplemental Fee $20 Transformers u to 10 KVA $10 Transformers over 10 KVA $ 20 Transformer I Power Su I for Si ns / Outline Li htin $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service andlor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit @$80 Add'Aional Ins ion Tri s $20 Investi ative Fee Reins ction Fee $20 TOTAL FEE (minimum total fee is $20) Z D_�' I hereby certi(y that I inspeded the elecUical installation descnbed herein on the dates stated: � Special Inspection $30 per Hour ��REO��,NOO�o S'al Ins on $.31 per Mile THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONT _. ,., I I IIII il I I IIIII � III II I11111IIIIIIIII IIIII��I �j (�� 1 8 4 8 L 4 3 2 `� �"� �`�� Rough-in Inspection Required? ❑Yes �No Inspection Other Than Rough-In: �Ready Now 0 Will Call �l�3 D�/ You must call the inspector when ready! Date Ready: 6�'� f 0`r I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at Job Site Street Address ��y � �Fo � , r�_ N E _ �r�t�. �7 I /� ���,�Y r / Companv Name � Mailing �/A/vrt � /V any or Owner Performing Installation) or Owner,Performi q nst a onf 1 Please Provitle 7wo (2) Phone Numbers Including Area dr4;) 7 6-�a3( ) License Number Master Eledrician or Power Limited 7 , _ License Number � � Numbers InGuding \ / EB-0000