P - 77661REQUEST FOR ELECTRI L INSPEC ION �`'�
� � 8 � 9 � � � � ��y, Minnesota Board of Electricity p�0.s • �,�� �� �
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 �
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(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -usiny the back of the white copy if necessary ; the work covered by this request:
I SERVICES I POWER
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL f
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofd @$.25 per Fixture
Center Pivot Irriaation Boom C� $40
Traffic Si nal Standard a$5
Sup lemental Fee a $20
Transformers u to 10 KVA a$10
Transformers over 10 KVA $ 20
Transformer I Power Su I for S' ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s a$20
Investi ative Fee
Reins ection Fee a $20
TOTAL PEE r:��� y�`�
(minimum total fee is $20)
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I hereby certiy that I inspected the electrical installation described herein on ihe dates slated: �
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10� �JVpQ(HOU� EXPIRE01A9CNDONED
pection @ $.31 per Mile
\LLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12
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18697698
Date: Rou h-in In
g spection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ! eady Now ❑ Will Call
9 ac� - vs- You must call the inspector when ready! Date Ready
I certity that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Sfte Street Address �" Y/ CRy
qf v� NE h-i�/-e��
Township Sectio=— Range' Fire No. Coun�
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Owner/O pant Name Please Pro�ride Two (2) Phone Numbers Including Area Code
� �� -�l �3)S7/-5201 ( )
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or
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YELLOW COPY
Contrador License Number Master ElecVician or Power Limked Technidan
�C ��� � License ����yy�� � � �
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Installa' n)
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alla on) Please Provide Two (2) Phone Numbers Including rea Code
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B ARD OF ELECTRICIN COPY Ee-00001A-15 n ��nna