P - 81934f REQUEST FOR ELECTRICAL WSPECTION
� Minnesota Board of Electricity "Y
1� 13 -7 - 3 2 4 182� ����e�s�� A�e��e S��=6 S-,2a, Saint Paul, Minnesota 55104 i
�`� ° (651) 642-0800 TTY/MRS 1-800-627-3�9
� www. electriciry. state. mn. us
Identiiy the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR / �-G � �
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES ! POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Amoere �$25 Su lemental Fee @$20
Above 800 Ampere
�UITS / FEEDERS
0 to 200 Ampere 4
Above 200 Ampere
CIRCUITS OF LESS THAN 50 VOLTS
ystem Device or Apparatus � $.50
ADDITIONS TO THE GENERAL F
LY DWELLINGS (PER UNI'�
Units � �.50 Per Unft
Retro�t �
Recreational
Transtormers u to to KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Ins ion Trips Each Dwellin Unft �$8(
Additional Insoection Trips � $20 .
I inspected the elecl
total fee is
herein ai ihe
� � Special Inspection �$ 31 per Mile I I �--�`� --� ` � �
__ THIS_INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFFlCE USE ONLY
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Request Date: Rough-in Inspectian Required7 ❑ Yes ❑ No Inspeclion Other Than Rough-In: �w ❑ Will Call
�'� �= ( You must call the inspector when ready! Date Ready:
I certiTy that i am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street� . or Route N. Ciry ��_� Zip Code
Ss�..��
Sectio Township Range Fre No. Counry _ �
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Phone
Electrical CoMract9f/ Company Name �ar v v v .a �tractor License
DEPENDABLE ELECTRIC, iNC. j p�
�'� � �m t Pertortning Instellation)
Goon Rapids, MN 55433
Authorized Signature (Con , ny or Owner Perfo � Instaflationj
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�E 1A-13 7/i/2000 BOARD OF ELECTNICRIf COPY
Phone
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