P - 77635REQUEST FOR ELECTRICA�P�T����
/� Minnesota Board of Electricity '�
��_� `t �- 5 4 6 1821 University Avenue Suite S-128, Sain Paul, Minnesota 55 04
(651) 642-0800 TTY/MRS 1-800-627-3529 -
www. electrici ry. state. mn. us
IdentiTy the work coveretl by this request:
❑ NEW ❑ REMODEL ❑ ADDITION REPAIR
GENERAL ES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental Fee �$20 �
401 to 800 Am re �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA (� $20
IRCUITS I FEEDERS Transformer / Power Su for Si ns / OuUine Li htin �$5
0 to 200 Am re �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuds and Two Inspection Trips Each Dwellin Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins 'on Tri s�$20
Each S stem Device or A ratus �$.50 Investi tive Fee
ADDITIONS TO THE GENERAL FEES Rein ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE
3 to 12 Units �$50 Per Unit (minimum total fee is $20) J�
EeCh Additi0nal U�it �$25 WR INSPECTOR USf�ONLY
OTHER ADDITIONAL FEES i �� S "F �, ( j �� \i � "L � �b � �y� �oo�L
Li htin Retrofit �$25 r Fixture �. �c�.�,�,cs r
CeMer Pivot Irti a6on Boom �$40 �
ManufaCturEd Home Patk LAtS �$25 I hereb ceAiy that I inspected the electrical insfallatlon described nerein on the dates stated:
Recreational Vehi�e Park Siles �$5 f01C"'" °A�
S rate Bondi In ion �$20
S ial I �$30 r Fbur Fl""""sv�"'a' o"h
S 'al In ' � $.31 r Mile ��� �`���
THIS INSTALLATION MAY BE ORDERED DISCON NOT COMPLETED WITHIN 18 MONTHS
FOR OFFIC U NLY
I f I I i I I I I I I 1 I I �� �"�- � j_
I I I( I I I l l I I I I I I I I I I I i 1 I I I I 1 1 1 1 1 I i l l�%�� ��
�E 1 3 4 7 5 4 6 2�E
Request Date: Rough-in Inspection Required7 ❑ Yes No Inspection O[her Than Rough-In: ❑ Ready Now �'Will Call
�%^' (T✓ You must call the inspector when readyl Date Ready:
I certity that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
.bb Address (Street, Box, or Route No.) City Zip Code
/�-pS - o.�.��i /�% -f ,2r`�0 �i7 5� 3 �
Section Township Range Fire No. Counry
� � �?� .uo%�
�l�Ji��7i'!/I`i� /i / . T f�! Gt/ �1 � d��wbst—, hone ,r ' ,� �' ( �� ' /`'_C�) �
40
Power Supplier
'k' ��L
Mailing Address
n�mo�zed s�am
�
7/1/2000
Company or Owner Perfortning Installation) —
. �6, . �r,.. SSy/�
dor, y o e erf ing stallation)
�
AHD OF ELECTRICITY Y
��
Phone
��L � 396 �D�'! 8�
INSTpUCT10NS ON BACK OF YELLOW COPY