P - 76053� REQUEST FOR ELEC�TRICA� INSPECTION
❑ Minnesota Board ofifl�tricity
1� 3 4 7= 4 4 7 � 1821 Universiiy Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-827-3529
www.electricity.state.mn.us
IdenUfy the work covered by this requast
❑NEW REMODEL ❑ADDITION ❑REPAIR
GENERAL FEES putdoor htin Standard �$1
SERdICES / POWER SUPPLIES Tre(fic Si Standard �$5
o ro aoo ��� iemer� r-ee ��zo
4Ut ro 800 Am re �$50 Tia�formers to 10 KVA �$10
Above B� Am re@$75 T�aretormers over 10 KVA �$20
CIRGUITS / FEEDERS Trarusfomrer / Power I for S / Out6ne �$5
0 to 200 Am ra @$5 ONE & TWO FAMILY DWEWN(;S, EACH UNR
Above 200 re �$10 Includes the Service and(or Power SupP�Y �P ���PB�, �
NARM, COMMUNICATION, REMOTE CONTROL, SIGNNJNG Circuiis and Two Ir�s on T Each Dwelfmg Unft �$80
CIRCURS, CIRCUITS OFLESS THAN 50 VOLTS Addidonal I on T �$20
Each m Device or �$.50 imesti ative Fee
ADDffIONS TO THE GENERAL FEES Reins n Fee ��0
MULTIFAMILY DWELUNGS ER UN TOTAL FEE
3 ro 12 Units �$50 Per Unit (minimum total fee is $20) �
EeCh AddiUo1181 Unit �,�L5 wx usrECron usE aa.r
OTHER AQDITIONAL FEES �'O�G��c � �` 7��`• f2`�7 �" a�'J •
Li Retroflt �$25 F6cture ij ,.�� =�^ ]C� �
Cerder Pivot Irti on 800m �$40 �n,,/ l/�J '"'� 6
Menulactured Home Park Lots �� i nere�'�v�s����i�prm� e�i�,�� �s� �•
__ TNIS INSTALLATI�N MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN�MONTHS
_ — FOR OFFlCE USE ONLY �--�'- � �
1111111111�I iflII11111 iili! III(1 IIIII illll 101I11f
�4 1 3 4 7 4 4 7 3�t
Reqt[eat Date: Rough-in Inapecdun Required9 Yes ❑ No Ir�ctlon Other Than Rough-In: ❑ Ready Naw ❑ W�1 Cell
b"� �/° v� You must call tlre Uispecoor when readyl Date Ready:
I cerMy that I am the ❑ LICENSm CONTRACTOR ❑ COMPANY OWNER and hereby reque.st mspectlon of the elecbical work at
Job Addr�s (Street, Box, or Route No.) Cfty � Z{p Cade
�D `� � e� s% L' �' � /� � ��� Z
S�tlon Township Range Flre No. Coumy
�
�� a � �%d o � P� "76 � -' %�� �Z �--
Power SuppAer pddreas
� � / .�r�
Electrical Contractor / Company Neme Contractor License Number Master Lice�e Numbar
MelAng A/ddr�s (Coritraactor. Company or Owner Pertomdng Ir�m�adon) .
�Gl P,IJ �' d� � o Q ��F � -� f2 �h /��i ST %G.� �/' /c��� l��! - SS ���
Authorized SI Contractor, Com�ny or Owner ertortNrtg Ir�tallatlon) Phone
• �%� fG �°� �/7-�-�Zr� Z--
EB�OOODIA-13 7/12000 BOARD OF ELEC�IiICRY COPY WSTqUCT10NS ON BACK OF YELLOW CAPY