P - 76463REQUEST FOR ELECTRICAL INSPECTION �
2� 0 V�� 0 1 3 �,' Minnesota Board of Electricity k� ;�,;
❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �,'
�j� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �a '
Describe -using the bacJ�pf the white copy if necessary - the work covered by this request:
L- G�7�C h � - � � '1 ' � �
' GENERAL FEES Outdoor Lightin Standard @$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere @$25 Supplemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transformer / Power Su I for Si ns I Outline Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Add'Rional Unit @ $25
OTHER ADDITIONAL FEES
Li hting Retrofit $25 per Fixture
Center Pivot Irriaation Boom (�a $40
Hour
Mile
4Y I
Illl lllll il lll II III II III II III II III II III NUI I�
?0810131�
Fee $20
TOTALFEE
iimum total fee is $20) �%�
I inspected the electncal installation descnbed herein on the dates stated: �
��-- � � l��
�
DISCONNECTED IF NOT COMPLETED WITHIN 12
,�c�� -ti ����
Date: Rough-in Inspection Required? ❑ Yes �Na Inspection Other Than Rough-In: ❑ Ready Now�l�Vill Call
1�� 1�� � You must call the inspector when ready! Date Ready:
I certify that I am the�CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site SVeet Address City `
�d �����-�� ��- �►� r, �
Township Section Range Fire No. County
��
13562 C�ntrai Ave NE
Mailing Address (Co a ing
„ 763-7,67�62�2 �°
Please Provide Two
/
3C[O� LiCEfISC NurtIDBf MeSt6f tlBCtfiGefl Of
�Q 1 � � � License Number
Area
Please Provide Two (2) Phone Numbers Including Area Code
� 1 \ /