P - 76696REQUEST FOR ELECTRICAL INSPECTION �'�
2 049� 9�9 2� �� ��
� -� � Minnesota Board of Electricity t ::�„
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 ���.�
C� �� (651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of t hite copy if necessary - the work covered by this request: + c�
�c� ` I - `7-1 / " � U 0 �
GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere @$25 Supplemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Amoere na $75 / � S Transformers over 10 KVA (�p $ 20
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Manufactured Home Park Lots (�
Recreational Vehicle Park Sites
THIS IN_STALLATION MAY BE ORDERED
i IIII II III II III II Ilf II III II III N II II III ��I I�I�
�Q499992
includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Addflional Ins ion Tri s $20
Investi ative Fee
Reins ion Fee $20
TOTAL FEE � �q ^_�
(minimum total fee is $20) U
THIS AREA FOR INSPECTOR USE ONLY
G�G�-�_ � 6 � z
I herebv certi(v that I insoected the electrical installation described herein on the d� s slated:
l-�2 y-�� �
TED_IF NOT COMPLETED WITHIN 12 Mi
,,��; %c> � ^-�> �� S i �
uace: Rough-in Inspection Required? ❑ Yes �No Inspection Other Than Rough-In: � Ready Now il Will Call
�•rl,U� r`
You must call the inspector when ready! Date Ready:
I certify that I am the,�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Stree ddress City
`�l� 3 i�o�� l� 1 v�. , r 1 d
Township Section Range � Fire No. County
���f�
Owner/Occupant N e Please Provide Two (2) Phone Numbers Including Area Code
n�1 ��^ r_��r�c �.., �r;�)S'1 I -CSc� � )
13562 Centrai A e
any �
763-757-6202
:ontrador. Comoanv or Owner Perfoi
or
License Number I Master Electrician or
. .-�.. � License Number
� � � �