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P - 78633REQUEST FOR ELECTRICAL INSPECTION �. � � � � � � 0 Minnesota Board of Electriciry � � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-0800 TTY/MRS 1-800-627-3529 www. electriciry. state. mn. us Identify the work covered by this request: /�� tl S?�RN`��• �i�yl��r i-J // iry��, NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR GENERAL FEES Outdoor Li htin Standard �$1 0 to 400 Am re � 401 to S00 Am re � Above 800 Am re � CIRCUITS / FEEDERS 0 to 200 Amcere � $ CIRCUITS OF LESS THAN 50 VOLTS ystem Device or Apparatus � $.50 ADDITIONS TO THE GENERAL FEES OTHER ADDITIONAL FEES Lighting Retrofit � $25 per Fixture Cemer Pivot Irrigation Boom � $40 Manufactured Home Park Lots � $25 Recreatanal Vehide Park Sites � $5 Trattic Si nal Standard � $5 Su lemental Fee f� $20 Transformers u to 10 KVA �$10 Transformers over 10 KVA � $20 Transformer / Power Su for S' ns / Outline Li htin � 35 ONE & TWO FAMILY DWELLINGS, EACH UNIT Indudes the Service and/or Power Supply up to 500 Amperes, All Circuits and Two Inspectbn Tri Each Dwellin Unft ��8( AddiGonal Insoection Trios �$20 F`� n Fee � total fee is � I I Special Inspeclion �$.31 per Mile � � ( J% — a-�o -� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS FOR OFFICE USE ONI.Y �� f IIIIII illll Illll ilill IIIII IllII CIIII Illfl El�l IIII � � �E 1 3 3 5 5 c 9 Z iE � � Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspecllon Other Than Rough-In: ❑ Ready Now ill Cal� 1/ 6/ 0 3 You must call the inspector when ready! Date Ready: I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeclion of the electricai work at: Job Address (Street, Box, or Route No.) City Zip Code 8151 Riverview T�rr NE Fridl Section Township Range Fire No. County I Occupant Doris Schmitmue I Mailing Address (Contractor, Company or Owner Performing 6451 i�cKinl�v_ St_ NW. Anoka Phone 763-784-07 Contractor Lfcense Number re ( o r Owner Pertorming Insiallation) Phone �� 763-422-9881 7/1/2000 BOARD OF ELEC7RICITY COPY � MISTHUC�IONS ON BACK OF YELLOW COPY