P - 77563pc REQUEST FOR ELECTRICAL INSPECTION '�
1� O V�- 7 9 4 � Minnesota Board of Electricity �-
I /f�`/ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �.
(/ �� (651) 642-Oa00 TTY/MRS 1-d00-627-3528 www.electricity.state.mtt.us
Describe -using the back of the white copy if necessary - the work covered by this request: D{l��
� v C%i�15cY� �Sl — %%�- %$ �S .s- �
GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am ere $25 Su plemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over t0 KVA $ 20
CIRCUITS I FEEDERS Transformer I Power Su I for Si ns I Outline Li htin $5
0 to 200 Am ere $5 (JY� C( (� ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CANTROL, 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 Aooaratus (a� $.50 Investipative Fee
� MULTIFAMILY DWELLINGS (PEI
3 to 12 Units a(� $50 Per Unit
FEES
Center Pivot Irrigation Boom �$40
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5
Se rate Bondin Ins 'on $20
S ial ins ion $30 per Hour
S ial Inspection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED D
� �i�� I� III II III �i �il E� ��� �� �i� �I �I� �� ��� ��I � �E�
18687947
TOTALPEE � ^
total fee is $20) �Ci • J v
I inspeded the elecVical installatlon desaibed herein on the dates stated:
�
COMPLETED WITHIN 12 MONTHS
� ;: � ,, .>F.:.
Date: Rough-in Inspection Required? ❑Yes �No Inspection Other Than Rough-In: ❑ Ready Now ❑Will Call
r- 5� �� Yau must call the inspedor when ready! Date Ready:
I certify that I am th@�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address C�Y
35S(� /2�'�e C/���K Te�t��� �'�,'C�(ey
Townshio Sedion Ranae Fire No. � County [
�
�
-9�Sf � )
License Number I Master Electrician or
., ,� �. � LicenseNumber
Please Provide Two (2) Phone Numbers Including Area
\ / \ /
E6.00001A-15
Code