P - 76811c REQUEST FOR ELECTRICAL INSPECTION °°��'�
2 w 1 Q��� � 5 O � Minnesota Board of Electricity �/� �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
{1�(��,�0 (651)642-0800TTY/MRS1-800-627-3529www.electricity.state.mn.us
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Descri -using the back of e white copy if necessary - the work covered by this request:
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GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am ere $25 Supplemental Fee $20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I Power Su I for Si ns / Outline Li htin $5
0 to 200 Am ere $5 ► f 1 1 O{'1�..°1^ ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ction Tri s $20
Each Svstem Device or Apparatus (�a $.50 Investiaative Fee
Unit @
Lighting Retrofit @ $25 per Fixture
Center Pivot ImqaGon Boom l�a $4C
S ial Inspection $.31 r Mile
THIS INSTALLATION MAY BE ORDERE�
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21678503
TOTAL
total fee is '
I hereby certify that I inspeded the electrical installation described herein on the dates stated: �
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D_IF NOT COMPLETED WITHIN 12 MONTHS
REC'D JUN 2�7 :2001
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Date: 'A� /�� Rough-in Inspection Requi2d? ❑ Yes No Inspection Other Than Rough-In: ❑ Ready Now Will Call
{.Y �
�� You must call the inspector when ready! Date Ready:
I certi(y that I am the,�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address ��y
59 ic ee 1� (Zoc�� r�� �
Township Section Ranae Fire No. Count�
0
Utility
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IFI�rF"ertortning Installa6on)
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Perfortning In� lation)
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Numbers Including Area
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Li i nse umber Master Elechician or
J1/O License Number
hone Numbers
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