P - 81875REQUEST FOR ELECTRICAL INSPECTION
1. � 19 312 �° Minnesota Board of Electricity —
R� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� �s�' (651) 642- TTY/MRS 1-S00-fj�7-3529
v www.e ctriciE�statemn.us �
Identity the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR I�" Y e • f
GENERAL FEES Outdoor Liahtino Standard �$1
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere f� $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Unfts �$50 Per Unit
Center Pivot Irrigation Boom � $
Manufactured Home Park Lots �
� $30 per Hour
(� $.31 oer Miie
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns / Outline Li htin C� $5
ONE & TWO FAMILY DWELLIN�S, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Tri s Each Dwellin Unit �$80
Additional Ins ection Tri s�$20
Investi ative Fee
Aeinsoection Fce � $20
total fee is
^��
I herebv ceAifv that 1 insoected the electrical insfallation described herein on tlie dates sta�d:
. �'"r,' '��
FOR OFF�E I�E ONLY
� �i�iri �i��i �iii� ����� i��ii ���1 ii��i ��i� i��i � * ��' •
� 1 1 1 9 3 1 2 5�E � �• SD
R Date: Rough-in Inspectlon Required? ❑ Yes ❑ No Inspection Other Than Rough-In: Ready Now ��11 Call
' ' Q/ You must call the inspector when readyl Date Ready:
I certity that i am the LICE CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, oX No.� _ ny zro coaa
� � 3°�t
Section Township Range Fire No. County //r/ `"'`//�—
l
Occupant ' Phone� � ` �� _ ��
7
Power Supplier Ad ress
i
Electrical CoMractor ompany ame � Cantrador License Number Master License Num r
DEPENDABLE I
Mailing /��S�C�r, Q�ne�ior � P�ing Installation)
�.ar�
Caon Ra ids. 5433
Authorized Signatu ntractor, Company or Owner ertorming Installation) Phone
_ _ r--/b��
� �i
E&OOOOtA-13 7/1 BOARD OF ELEC7AICITY COPY IN37AlIC710NS ON BACK OF YELLOW COPY