P - 77539RECIUEST FOR ELECTRICAL INSP CTIO �
1 � Q���/� Q/� � Minnesota Board of Electricity ��—�� ��
V •� •� •-f ❑ 1821 University Avenue Suite S-128, Saint�aul, Minnesota 55104
(651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us � ':�
Describe -using the back of the white copy if necessary - the work covered by this request: 6�� J�
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GENERAL FEES Outdoor Lightin Standard $1
SEWGICES I POWER SUPPLIES _ � Traffc Si nal Standard $5
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Abave 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CANTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A paratus $.50
ADDITIONS TO THE GENER4L F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
FEES
Center Pivot Irrigation Boom @
Manufactured Home Park Lots i
Recreational Vehicle Park Sites
Su plemental Fee $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee @ $20
TOTALFEE
iimum total fee is $201
I hereby cert'rfy that I inspected the electri I installation de�ibed �n on� da mted:
ROUGHIN • � � 4�� A=�
Special Inspection @$.31 per Mile �
THIS INSTALLATION MAY BE ORDERED DISCONNECTE
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COMPLETED WITH
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Date: Rough-in Inspection Required? �es ❑ No Inspection Other Than Rough-In: ❑ Ready No�Will Call
�Z�� 'QS You must call the inspector when ready! Date Ready:
I cerfrfy ttiat I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ,�6WNER and hereby request inspection of the electrical work at:
Job Site SVeet Address ��Y
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Townsh�1 Section Range Fire No. �` Cou t��C�
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� Mailing Address (ConVactor,
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any or Owner P
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or Owner Perfoi
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Contrador License Number Master Electrician or Power Limited Techni
License Number
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PI Provide Two (2) Phone Numbers Including Area Code
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CTRICIN COPY EB-00001A-15 8.1,