P - 77662p1 REQUEST FOR ELECTRI(��L IN PECTI N ����`�.
1 i O 1�- 5 9 9� Minnesota Board of Electricity —� `�/�� �pZ��� �� �
S ;'p�,.
1821 University Avenue Suite S-128,`Saint Paul, Minnesota 5104 �
. (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the b�ack�the whl�,opy if necessary - th� worl�o1rered by this reque�t: i �_ .. . A
401 to 800
Above 800
CIRCUITS I FEE
CIRCUITS, CIRCUITS dF{f55iHAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units an $50 Per Unit
Frt @ $.25 per Fi#ure
rigation Boom @ $4(
Home Park Lots C�a $
ecial Inspection @$.31 per Mile �
INSTALLATION MAY BE ORDERED
I IIII II III Ei lil II IIi II III II III II III II III q� I�
L 8], 2 5 9 9 7
Su plemental Fee $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 Inspec6on Trips Each Dwelling Unit @$80
Additional Ins ection Tri s a$20
Investi ative Fee
Reins ection Fee $20
TOTALFEE
(minimum total fee is $20) c
rtiTy that I inspeded the electrical installalion described herein on the dates stated:
OATE
ION DATE
t - / `� .��G,
C
�NDONED pq�
IF NOT COMPLETED WITHIN 12 MONTHS
°"' /� Rough-in Inspection Required? ❑Yes �No Inspection Other Than Rough-In�F{eady Now ❑Will Call
l,/{ ✓ �
You must rall the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY O OWNER and hereby request inspection of the electrical work at
:tor / Company Name
�arrison Elect In
Address (ConVactor, Company or Owner Performing Installati�
3440 Kilrner Lane N
ized Signa re(Contractor or Ownar Perfortnina Installationl
Fire No. Coun� (�
\(1....�. _ V n U
�'\V ��::�% =
Please Provide Two ) Phone Numbers Including Area Code
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[or License Number Master Eledrician or Power Limited Techni
License Number
�00�0$
outh 55441
Please Provide Two (2) Phone Numbers Induding Area Code
'�63 �44-3300 ( )