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P - 81710REQUEST FOR ELECTRICAL INSPECTION � k, � Minnesota Board of Electricity —,, 1��%� ����� �� 1821 University Avenue Suite S-128, Saint Paut, Minnesota 55104 � (651) 642-0800 TfY/MRS 1-800-627-3529 www. electricity. state. mn. us Identiiy the work covered by this request: ❑NEW ❑REMODEL ❑ADDITION ❑REPAIR//'-I'{IxCJ �'"^"'''' 407 to 800 Ampere � Above 800 Amoere � 0 to 200 Ampere � $5 Above 200 Ampere � $10 RM, COMMUNICATION, REMOTE CONTROL, �UITS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device a Apparatus �$.50 ADDITIONS TO THE GENERAL f Each Additional Unit � $25 OTHER ADDITIONAI FEES Manufactured Home Park Lots � Recreational Vehicle Park Sites � Seoarate Bondina Insoection � $� Outdoor Li htin Standard � $1 Traffic Si nal Standard @ $5 Su lemental Fee � $20 Transtormers u to 10 KVA �$10 Transformers over 10 KVA � $20 Transformer / Power Su i for Si ns I Outline Li htin �$5 ONE & TWO FAMlLY DWELLIMGS, EACH UNIT Includes the Service andlor Power Supply up to 500 Amperes, All CircuiGs and Two Ins ection Trips Each Dwelling Unit �$8C Additional Ins ection Tri s�$20 Investi ative Fee Reinsoection Fee C� $20 I insoected the total fee is on tlie dates stated: Special Inspection �$ 31 per Mile � v" ` �- 2 2-o� � THIS INSTALLATIOM MAY 8E ORDERED DISCONNECTED !F NOT COMPLETED WITHIN 18 MONTHS FOR OFFICE USE ONLY � ����i� N«�l ri��� ����� ii��i ���� «iii ���� �i�� � � �� • �c 1 0 7 9 9 9 D 6� �� �� Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: eady Now Wltl Call / 7' Q' You must call ihe inspector when ready! Date Ready: I certify that I am the ICENSED CONTRACTOA ❑ COMPANY ❑ OWNER and hereby request inspection of the elecfical work a� Job Address (SVeet, Bo , or Rou[e o City � ZP � �� car.rcnn Tnwnshiu Ranoe Fire No. ' CounN i OccupaM .. Power Supplier ConVad�r / Company Name PENDABLE ELECTRIC. , � ap4dr�#s� �n Rapids, MN�55433 3d Signature (C ctor, Company or C � � EB-00001A43 Phone ' � ��9 Conbactor License Number �nsranaU«,> ning Installation)' I - BOAND OF ELECTWCRV COPY - �s7-S�1 I MgTpUC710NS ON BACK OF YELLOW COPY