P - 82491` � REQUEST FOR ELECTRICAL INSPECTION
1 ��� ��� y Minnesota Board of Electricity -
►� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
• �� �.-; (651) 642-0800 TTY/MRS 1-800-6273529
� www.electriciry.state. G'�5
Identify the work covered by this request: �O n� eG /� �
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❑NEW ❑REMODEL DDITION REPAIR /�
GENERAL FEES 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 S00 Am re�$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortner I Power Su I for Si ns I Outline Li hti �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY OWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two In on Trips Each Dwelli Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or A ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins 'on Fee �$20
MULTlFAMILY DWELLINGS PER UNI TOTAL FEE
3 to t2 Units �$5o Per Unit (minimum total fee is $20)
Each Additional Unit � $25 FORiNS�`�0" `�E °NL
OTHER ADDITIONAL FEES
' Min RetrofA � $25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots 5- I he ce ' mat I inspected me electrical installation described herein on the �tes stated:
Recreational Vehicle Park Sites "�" �' °�'�
Seoarate Bondina insoectiort f� $20
FOR OFFICE USE ONIY
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I�(��� ���(J(,J � You must call the inspector whe� readyl � Date Ready: �
I certify ihat I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeclion of the electrical work aY.
Jab Address (Street, Box, or Rou[e No.) Ciry T�p Cade
�134 a�k �- lll �r' �
Section Township Range Fire No. Coun ,
� Occupant
Power Supplier �J Addre_ss
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Electrical ConVactor / Company Name
DEPENDABLE ELECTRIC, INC.
M�I��dr�h�p�p eAorming
Coon Rapids, MN 55433
Authorized Signature ctor, Company or Owner e i
EB-OOOOtA-73 �/1/2000 �
Phone
��3 -'7�5-
n� Number Master Licer
Installation)
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BOAND OF ELECTAICRY COPY �---.. INS7HUCT�OMB ON BACK OF YELLOW COPY