Loading...
P - 79722REQUEST FOR ELECTRICAL INSPECTION ` Minnesota Board of Electriciry � �� 19 7- 8 4 2� 182� University Avenue Suite 5-128, Saint Paui, Minnesota 55104 � ae �� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us `��' Identity the work covered by this request: ❑NEW EMODEL ❑ADDITION ❑REPAIR ( j "TG� �' ���� S GENERAL FEES Outdoor Li htin Standard �$1 SERVICES / POWER SUPPLIES Traffic Si nal Standard (� $5 O io 400 Am re �$25 Su lemerrtal Fee C� $20 401 to 8� Am ere �$50 Transformers u to 10 KVA �$10 Above S00 A re �$75 Trar�sformers over 10 KVA �$20 CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin �$5 0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT Above 200 Am re�$10 Includes the Service andlor Power Suppty up to 500 Amperes, All ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling UnR C� $80 CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri �$20 Each Svstem Device or Aooaratus �$.50 Investiaative Fee 3 to 12 Units �$50 Per UnR �m�nimum totai ree is yzv� / �/ EaCh Add'Rion81 Unit �$25 WP INSPECTOfl USE ONIY OTHEfl ADDITIONAL FEES Li htin Retrofit �$.25 r Fixture Center Pivot Irri ation Boom �$40 Manufactured Home Park Lots �$25 I hereby certity that I inspected the electrical installation described herein on the dates stated: Recreational Vehicle Park Sftes � fl01�"'" °"� S rate Bondin In ection � S ecial Ins ection �$30 r Hour Fl""""��10N °"'� S ecial Ins ection �$.31 r Mile THIS INSTALLA710N MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS __ FOR OFFICE USE ONLY � ���t�� ����� ���f� ����� ����� ��1�� ����� ���f� �i�� ri�� � 1 1 9 7 8 A 2 6� �S�Z �,�� Reque Date: RougMin Inspection Required? Yes ❑ No Inspec[ion O[her Than Rough-In: ❑ Feady Now � WNI CaN � � You must call the inspector when readyl Date Ready: I certity that I am th�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: Job Address (Street, Box, or Route No.) C'dy Zip Cod�e / �o r� �, rfo� D�vC �.0 ��.c •`' � 7c�°� Section Township Range Fire No. ounty �v � �{ND�Li9 Occupant ��� Phone Power Supplier Addre ,i( �.�.. LS a,2�� � � ��s�c��J Electri I Contractor / Compan N me Contractor License Number Master License Number �;f� ���L�-� � 03� �3 Mailing Address (CoMrac[or, Company or Owner Perfortning Installatfon) � 7� �D''?'J� /r/� ��w� � �SS �� Authorized Si r, Co or Owner Partorming InstaNation) Phone rj�� _�L ��yl 6 �- �- E /2000 BOAHD OF ELECTfi1CT/ COPY IN3TRUCTIONS ON BACK OF YELLOW COPY