P - 78949REQUEST FOR ELECTRICAL INSPECTION
�— 6 7 2— 2� 2❑2 Minnesota Board of Electricity -
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651} 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
�MEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
� � 8��- t.c 1..1 r,
G NE FEES utdoor Li htin andard $1
SERVICES / POWER SUPPLIES Tra�c Si nai Standard $5
0 to 400 Am re $25 Su lemental Fee $20
4D1 to 800 Am re $50 Transformers u to t01NA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CtRCUITS 1 FEEDERS Transformer ! Power Su I for Si ns ! OuUine Li hGn $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 Additional Ins tion Tri s $20
Each S stem Device or aratus $.50 InvesG ative Fee
ADDITIONS TO THE GENERAL FEES Reins tion Fee $20
MULTIFAMILY DWELLINGS PER UNIT �� � TOTAL FEE
3 to 12 Units @$50 Per Unit nimum total fee is $20} a•��
Each Additional Unit @$25 rr+isna�r, coa iruaECTOa usE acr
I hereby certify that I inspected !he electrical installation deuribed herein on the dales sqted:
OTHER ADDITIONAL FEES
htin Rehofit $.25 er Fixture
Center Pivot Irri ation Boom 840 R°W"'" °"TE
Manufacturetl Home Park Lots $25
Recreational Vehicie Park Sites $5 """""�cT'°" arE U'
arate Bondin Ins tion $20 -- /3�� T
S ial Ins tion $30 r Hour E%PWED/eBNOOqED w,e
5 iallns tion $.37 Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
'/..rliill����l�l��l��lf I��jl�lf���
1 6 7 �I� � �
22522 ��`i�
�
� ce�Y that I am 1he
►a
ng qtl�
��y
Rargh-in fnsp��on Required? �(./�.J�-l/ /J �9 � `7�
1'ou musi cep trye ins Y� /
�ENSED CpNT►;q aecca wr,e„ ,eadn �^gAectF°n OtA� Than Ro�gh-In. NY Wow Q
CTOR QC oare►�ay: waicau
or Roure n�o.� �A�'n' ❑ OWNER and hereb
�;:y Y�Q�est inspe� ���I work at:
��� . 1�'-�., u , _ ,_ _ .
� "'�__� �r��
-�—�
b� . . __.._..�.�nc�s1� �� �
� � /
: Number M�� �an or
.� ? (,%1' Li Power limrtea redr,ia,
�L.�
��8 (5�
�r� ssa� ���
EB•UOOOfM14 B.t �mo