P - 82504REQUEST FOR ELECTRICAL INSPECTION
Q C, Minnesota Board of Electricity `�
�. �0 2 5� J� aJ d�° 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� '�� (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
IdentiTy the work covered by this request:
�NEW ❑REMOOE� ❑A�oirioN �EP,aIR E LOOSE FROM MAST TO METER(replace S0YV1C2
GENERAL FEES ' r i n ard �$1
RVICES / POWER SUPPLIES Traffic Si nal Standard �$5
to 400 Am ere �$25 Su lemental Fee �$20
40 to 800 Am ere (� $50 Transformers u to 10 KVA �$10
Above 800 Amoere (� $75 Transformers over 10 KVA �$20
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or ratus �$.50
ADDITIONS TO THE GENERAL f
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per UnB
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofil �$25 r Fixture
Center Pivot Irri atbn Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5 !°
Se arate Bondin Ins 'on � $20
Soecial Insnection � $30 cer Hour
Transformer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
CircuRs and Two Inspection Trips Each Dwellin Unit �$80
Additional Ins ection Tri s�$20
Investi ative Fee
Reinsoection Fee � $20
that I
FOR OFFlCE USE ONLY
i«�ii i�ii� ��F�i i��i4 ��i � i� i��ii �»� �ii� � ����
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�E 1 Q 2 5 9 3 5 b 34 a�, 50
(minimum total fee is $20) 2� •
al ir�talladon de.scribed herein on tlie dates stated:
onh
wre
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�LETED WITHIN 18 MONTHS
�
Rough-In: Ready Now ❑ WNI CaN
�1��2(—�� � Yau must call the inspedor when readyl � Date Ready: �
I certify thai I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, Box, or Route No.) City Zp Code
41 OSBORNE WAY FRIDLEY 55432
Section Township Range Fire No. Counry
Occupant P�� 572-9633 651-628-0509 Wor
CHUCK BROST-,
Power Supplier �� r"; � •, Address
i {�
ElecVical Contrador / Company Name Corrtractor License Number Master License Number
OTAL ELECTRIC, INC. CAO 2749
Mailing Address (CoMractor, Company or Owner Perfortning Installation)
10760 0 ST NE SU 1 BL INE MN 55449
Au[horized Sgn r(ConVador, Company er Ped tion) Phone
763-786-8484
EB-OOOOtA-73 /1 BOARD OF ELECTRICT/ COPY INSTNUC710NS ON BACK OF YELLOW COPY