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P - 82452REQUEST FOR ELECTRICAL INSPECTION � � Minnesota Board of Electricity `� 1��J 2 6� g 2 7 _e��v 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 "i j (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us '� � Identity the work covered by this request: "iQ _� J�—�� `�.�,� ,,! �� ❑NEW EMODEL ❑ADDITION ❑REPAIR � — GENERAL FEES Outdoor Li htin Standard �$1 SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5 0 to 400 Am ere �$25 Su lemental Fee �$20 401 to 800 Am ere f� $50 Transformers u to 10 KVA �$10 Above 800 Am ere �$75 Transformers over 10 KVA �$20 CIRCUITS 1 FEEDERS Transformer / Power Su 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 Suppty up to 500 Amperes, All ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 'on Tri s�$20 Each S stem Device or A aratus �$.50 Investi ative Fee ADDITIONS TO THE GENERAL FEES Reinsoection Fee �$20 OTHER ADDITIONAL FEES Lighting Retrofit � $.25 per Fixture Center Pivot IrrigaUon Boom � $40 Manufaclured Home Park Lots � $2 Recreational Vehicle Park Sites � $ Separate Bonding Inspection � $20 Special Inspection � $30 oer Hour total fee is /�/G/ g.Z6-o� � that I inspected the ek�ctrical installatian described herein on tl�e dates sqted: w� = �3 I FOR OFFICE USE ONLY � ��i�� i�a �i��i �� t�� i�� a�� l��a ua �y � � 3E i O Z 6 9 c 7 c�' 3E �� PD�S Request Date: RougFrin Inspection Required? ❑ Yes No Inspection Other Than RougMln: ❑ Ready Now ill Call ��p You r�t call the inspector when ready! Date Ready: I certi(y that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at Job Address (Sheet, 8ox, or Ro No.} Ciry Zip Code , c ' �./L/ � ' � �3 Section Tbwnship Hange Fire No. Co Address 135�,2 CENTRAL AV Idres Contracta, ny or Owner ture ( t Company w0 Phone _�� ,� � -��a� Licenae Number � \_JU �y'W1��"c:U--C.V I / eJ / ' /7 / � to d,U d---I, 7/1/2000 BOARD OF ELECTRICIiY COPY � INSTRUC710NS ON BACK OF YELLOW COPY