P - 77575REQUEST FOR ELECTRICAL INSPECTION -=� �
1 � 811-17 3� Minnesota Board of Electricity �-
1821 University Avenue Suite 5-128, Saint Paui, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
�..�
Describe -using th ck of the hite copy if necessary - the wo ered by his request: _ �j� �,� /� /��/
� SERVICES / POWER SUPPLIES
0 to 400 Amcere na $25
2M, COMMUNICATION, REMOTE CONTROL, SIGNALING
:UITS, CIRCUtTS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus (�a $.50
Unit @
L�hting Retrofit @ $.25 per Fixture
Center Pivot Irriqation Boom C�a $4(
Outdoor Li htin Standard $1
Traffic Si nal Standard a$5
Supplemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Su I for Si ns / Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Inciudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTALFEE
total fee is $201
I herebVi certiry that I inspected the electncal installation descnbed herein on the dates slated: �
Se arate Bondin Ins v'on V$20 V � Z�—�
Special Inspection @$30 per Hour E%PIREOIABANDONED on�
Special Inspection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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uace: Rou h-in Ins ection R uired?
g p eq ❑ Yes ❑ No Inspection Other Than Rough-In: eady Now ❑ Wiil Call
�' (Q �D � You must call the inspector when ready! Date Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job S� � t Ad�ss � City c
_ `
Township S tion Range Fire No. oun _
'ENDABLE ELECTRIC, INC.
, rforming Installal
Coon Rapids, MN 55433
d Signatu ctor or Owner Pe/f rming InstallaGon)
( r7�� �3 ,g./�S' >
ise Number Master Electrician or P
� License Number
Please Provide Two (2) Phone Numbers
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