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P - 77433p/� REQUEST FOR ELECTRI L INSPECTION � � �� O�F �� 6� 1� Minnesota Board of Electricity p��,s-� ar3� � ,�� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � � (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us ��" D ribe -using the baCk of the hite cop if necessary - the work covered by his requ t: � 'LL'c��G��_�1:� I.'lC..�C`�� '� �l, � % �'�, SERVICES / POWER SUPPLIES 0 to 400 Ampere @ $ 401 to 800 Am ere $50 Above 800 Am ere $75 CIRCUITS I FEEDERS 0 to 200 Am ere $5 Above 200 Am re $10 ALARM, COMMUNICATION, REMOTE CONTROL, CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device or A paratus $.50 ADDITIONS TO THE GENERAL F MULTIFAMILY DWELLINGS PER UNIT 3 to 12 Units @$50 Per Unit Each Additional Unit @ $25 OTHER ADDITIONAL FEES li hting Retrofd @$.25 per Fi�Rure Center Pivot Irri aGon Boom $40 ManuNactured Home Park Lots $25 Recreafional Vehicle Park Sites (� $5 THIS INSTALLATION MAY BE ORDERED C I 11lI II III II III II III II II! II NI II lil II III �� I� 184768L2 . Outdoor Li ting Standard $1 Traffic Si nal Standard @ $5 Su lemental Fee a $20 Transformers u to 10 KVA $10 Transformers over 10 KVA $ 20 Transformer / Power Su I for Si ns / 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 Inspection Trips @ $20 � Investiqative Fee TOTAL FE j I t� �, total fee is $20 � I inspected the electrical installation desaibed herein on the dates stated: � IF NOT COMPLETED WITHIN 12 L°`�� ,.�/ ,^ ��� Rough-in InspecGon Required? ❑ Yes ❑ No Inspectian Other Than Rough-In: ❑ Ready / /i (r f/ You must call the inspector when ready! Date Ready: I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tf Job Site SVeet Addre ��, y5� .�c.��c�--� �C ���1 �;�;,�/.,�. C ���� ��9 ElecJVical Utili l'�f' t. �/ ! �� ame ,� �� �l ��f %( :tor, Company or Own P rtning Install � -�� � �a�� � io V r r wner Perfortning Installatioi l )F YELLOW COPY BOARI -•Z� � �ci I Call work ai - l��'�'�..� Please Provide Two 2) hone Numbers Including Area ( ��� � C� ��' ( ) "f—J7 �c.,� G=t'� �t.� - ;ontrador Li nse Number Master Electrician or Power Limited l �Q�, ���� . �' License Number� /�,�, ,,� _� i� �, , ��� l � ��� �✓!✓/ 6� t,.� � /�Zk%/� �2ti�'� P/� �'d(�'1 Please Provide Two (2) Ph e Numbers Including Area ���/1��'� �, r ��I�/'�'� �C� fRICITV COPY rasnnm e_. c