P - 77749REQUEST FOR ELECTRICAL INSPECTION �
M�nnesota �oard nf ElectriCity � �
1� 3 4 7- 4 4 8 1821 University Avenue Suite S-728, Saint Paul, Minnesota 55104
(651) 642-0800 lTY/MRS 1-800-627-3529 =
www. electricity. state. mn. us
Identity the work covered by this request:
❑NEW ❑REMODEL f�ADDITION ❑REPAIR % � �' �
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 400 Am re�$25
401 to 800 Am ere �$50
Above 800 re � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S siem Device or aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Unfts �$50 Per Unit
OTHEF ADDITIONAL
Lighting Retroffi � $25 per F�Rure
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � S25
( f ' .-wt � � e�-. �- � , �'Z r- �,..�.�
Outdoor Li htin Standard � $1
Traific Si nal Standard � $5
Su ental Fee � $20
Transformers u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transfortner / Power Su I for S' ns / Outline ' 6 8$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8(
Additional Inspection Trips � $20
Investiaative Fee /�n _
total fee is $20) {�/.
207�5�—� dS�
I hereby certity ihat t inspected the electrical insfallation described herein on the dates siated:
Se arate Bondin Ins 'on � $20
S ial In 'on �$30 r Hour FlW1��MSPE�T�ON �� ,:�►'�t
S ial In ' n�$.31 r Mile (�
_ THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN yWNONTHS
FOR OFFICE USE ONLY
I IIINf IIIII IIIII Illli Ilili Illi! IIIII IIIII HII illl �
�E 1 3 4 7 4 4 B 1 �E
Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Ins ection Other Than Rou h-In:
p g ❑ Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certi(y that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY J�OWNER and hereby request inspection of the electrical work at:
Job Address (Street, x, or Route No.) City Zip �
�04�2 �� sT N Ft�.�DC� ssg32
Section Township Range Fire No. County
RNoI�
Occu nt Phone
4��s�N�. 7(��- s`71-�8�2
/ Company Name
I Mailing Address (Contractor, Company or Owner Performing Installation)
�- •,.�...
3 7/1/2000
, Comp�nKor Owner Pertortning
Contrector License
BOAHD OF ELECTRICRY COPY
License Number
P7� s�� -�8G Z �
INST(iUCTIONS ON BACK OF YELLOW COPY