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P - 77588REGlUEST FOR ELECTRICAL INSPECTION Minnesota Board of Electriciry 1� 4 7- 418 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � (651) 642-0800 T'fY/MRS 1-800-627-3529 www.electricity.state.mn.us ' � Identi(y the work covered by this request: n� r a� I /(� pNEW ❑REMODEL ❑ADDITION eHHEPAIR GENERAL FEES Outdoor U htin Standard �$1 RVICES / POWER SUPPLIES Treffic Si nal Standard �$5 0 to 400 Am re� 325 Su lemental Fee �$20 441 to 800 Am re �$50 Transformers u to 10 KVA �$10 Above 800 Am re (� $75 Transformers over 10 KVA �$20 CIRCUITS / FEEDERS Transformer / Power Su tor S' ns I Outlirre hti �$5 0 to 200 Am re �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT Above 200 Am re��10 Includes the Service andlor Power Supply up to 500 Amperes, All ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Unit �$80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s�$20 i Each S stem Device or aratus �$.50 Investi tive Fee ADDITIONS TO THE GENERAL FEES Reins ' Fee �$20 MULTIFAMILY DWELLINGS PER UN TOTAL FEE � 3 to �2 Units �$5o Per Unit (minimum total fee is $20) ; Each Additional Unit �$25 F0"1NSPEGOR "� 01Y I OTHER ADDITIONAL FEES I CeMer Pivot I' ation Boom �$40 Manufactured Home Park Lots �$25 I hereby ceAi thst I inspected the electrical insta�lation described herein on the dates stated: Recreational Vehide Park Sites �$5 f01GH1N �'h S rate Bondi Ins ' � $20 ial Ins 'on �$30 r Hour """` "u°E°10N o�,� S'al In n�$.31 r Mile ��r � 2�� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 1S MONTHS � .`,,,"- FOiIOFFICEUSEONLr � f�D/ - � � f� LI���il�� �f��l /�t� //�/ �� � �E 1 3 4 7 4 1 6 4�E �t/�"�� �! (p(p � �+9� ��ePeclbn R�q�A►ed9 Yes No Irrepsctlon Olher Then Rough•In: Ready Now Call � You must caN the irmpecbr when ready� ��Y� I ceNly 1 tl�e ❑ LICENSED GONTRACTOR ❑ COI�APANIf (�;pWNER and hereby request inePedWn of tlie elecfical wak, at V Job Address (Street� Box� w Route nb.) CitY ZP � • f /(,? �• /r�� �v _v �i �, � ; SSY� � � Sedion Towr�eh�P .,. Renge_ Fire No. CaiM�y �'"�' Name � AAe�ng Atldress (�r. Compaiy or Owner PeAomifng ingtaqation) ~� � p�yprized SlgneWre Owner Perlormk�g lnS�on):' �-00007M73 T/I1100C . . �� . � � �.:.�-� Phor� -3i7 , � { �� , � � ? / C/ � �! U 1I i11CIlOp6 ON BAt�C GF YEIAOw OOPY �