P - 77508REQUEST FOR ELECTRICAL INSPECTION ���
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1 i J U Q� 3 2 4 �? Minnesota Board of Electricity �-, I
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1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us � °
)escribe -�k'sing the back of the white co y iPnecessary - the work cov by this request:
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GENERAL FEES Outdoor Liphtinq Standard l�a $1
I SERVICES I POWER
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Ap aratus $.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit (� S25
OTHER ADDITIONAL FEES
ofit @ $.25 per Fixture
Irrigation Boom @ $40
i Home Park Lots $25
VehiGe Park Sites a(� S5
� Transformers up to 10 KVA @$10
� Transformers over 10 KVA @$ 20
� Transformer / Power Supply for Siqns / Outline Liqhtin $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 (�D $20
Investigative Fee
Reinspection Fee (�a $20
Sr'-/�
I herebv certifv that I
TOTAL FEE / �i�t
total fee is $20) L�•�� `�
the eledrical installation described herein on the dates stated:
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Speciallnspectfon $30perHour Exa�aeornenNOOr,e op
Special Inspection @ $.31 per Mile
S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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19683242 ������'�'����
Rough-in Inspection Required? �es ❑ No Inspection Other Than Rough-In: ❑ Ready Now�lp�ill Call
L � V(p You must call the inspector when ready! Date Ready
I certi(y that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site St� t Address City
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ador / Company Name
Ri_es Electric Company
Fire No. Cou ty �—
Please Provide Two (2) Phone Numbers Including Area
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nraavr uCense rvUrtID2f nnaster tlectncian or Power
CA01539 �icenservumber
Please Provide Two (2) Phone Numbers I
( 6.�1-451-2238 ( �