P - 77421REQUEST FOR ELECTRICAL INSPECTION �`�
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Minnesota Board of Electricit �v7�JF ��
, 1821 University Avenue Suite S-128, Sai�Paul, Minneso a�55� `� �
(651) 642-OS00 TTY/MRS 1-500-627-3529 www.electricity.state.mn.us ��
Descri e-using the back of th�j white copy if necessary - the work covered by this request:
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GENER,4L FEES Outdoor iqhtinq Standa�l(�a. $1
JICES / POWER SUPPLIES
0 to 400 Ampere @ $25
401 to 800 Ampere @ $50
Above 800 Amoere an $75
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit (� $25
Manufadured Home Park Lots a$25
Recreational Vehicle Park Sites $5
Se arate Bondin Ins ion $20
Special Inspection $30 per Hour
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED
Transformers over t0 KVA $ 20
Transformer / Power Su I for Si ns I Outline Li htin $5
ONE & 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
Additional Ins tion Tri s $20
Investi ative Fee
Reins ection Fee $20
TOTALFEE
(minimum total fee is $20)
THIS AREA FOR INSPECTOR USE ONLY
I hereby certify that I inspected the electrical installation described herein on the dates stated:
ROIIGHIN DAiE
12 MONTHS
.. I
I IIII II I�� II II II III II III I) III II III II III ��I I�
],87�2588�
Date: � Rou h-in Ins ection Re uired?
L g p q ❑ Yes Inspection Other Than Rough-I Ready Now ❑Will Call
� You must call the inspector when ready! Date Ready:
I certi(y that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address /1 .. . �, c�w . .
Provide Two
y ( )
ElectricalUtility Electnca UtilityAddress
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Contrador / Company Name Contractor License Number Master Electncian or P�
Harrison Eleet. Ine. CA �$/}Q License Number
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Mailing Address (Contr r, o Owner Performing Installadon)
����'�i�mer Lane N. Plymouth 55441
Authorized Si re(Contractor or O er Perfortning Installation) Please Provide Two (2) Phone Numbers I
'�63 �44-3300 ( )
INSTRI If.TIf)NC (11J rK !1F VF1 1 . D onnon n� ci crreiriTV rr.nv
Technician I