P - 76289� I�EQU.EST FOR ELECTRICAL INSPECTION
1��� �- 512 0 Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' , (651) 642-0800 TTY/MRS 1-800-6273529 www.edectf-icity.state.mn.us
Desceibe -using the back of the white copy'rf necessary - the work covered by this request:
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GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POUVER SUPPLIES Treffic Sfgnal Standard @$5
0 to 400 Am re $25 Sup lemental Fee @$20
401 to 800 Am re $50 Transfortners u to 10 KVA $10
Al�ve 800 Am re $75 Transformers over 10 KVA @$ 20
EfRC ITS ! FEEDERS Transfortner / Power Su I for Sf ns / Outline LI htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Abova.200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Tvro Inspection Trips Each Dwelling Unft @$80
CIRCUifS, CIRCUITS OF LESS THAN 50 VOLTS pdd�n��ai i���n�� T�,m r�n a�n
FEES
Fixture
Fee
total fee is $20) � ��� 5�
that I inspected the electriral installafion described here(n an Ne dates steted:
eBondi Ins ction $20 • a-�^�7
Spectal InspecUon @$30 per Hour °w�D�^�^"m0N oA,�
S ial Inspe�fion @$.31 per Mile
THI$ (NSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
I I�� II �I II I�� ��I II �1 IIuI u ul u W� I� I(IN
179751,29
REC'D JUN 14 2001
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��a�'' Rough-In Inspection Required9 ❑Yes �]No Inspection OtherThan Rough-In: [�,ReadyNow ❑Will Call
C�+f� �. �. ��� You must call the inspector when readyl Date Ready:
1 c�[tity that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Hddress
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r� r, ���.•r���, ������a �onuecior ucense rvumner mascer tiecmcian or Nower um
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A71�g Address (Contractor, Company or Owner Pertorming Installation)
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Aafhar(aed Signature (Contractor ar Owner Performing Installation) Please Provide Two (2) Phone Numbers Including
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� INSTRUCTIOIJ.4 ON ACK QF YEL�OW COW BOARD OF ELECTRICITV COPV va nmm