P - 79762` REQUEST FOR ELECTRICAL INSPECTION .•p..,
Minnesota Board of Electricity ° �
• 1-396-533 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 —
(651) 642-OS00 TTY/MRS 1 •800-627-3529
www.electricity. state.mn. us
Identity the work covered by this request:
X XC�L Eh1EROY SAVER'S SWITCH
❑ NEW ❑ REMODEL ❑ ADDITION O REPA�R
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traftic Signal Standard �$5
ITS/FEEDERS
to 200 Ampere �
?M, COMMUNICATION, REMOTE CONTROL, SIGNALING
�UITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
TIFAMILY DWELLINGS PER UNI �.
3 to 12 Unfts �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li_ hting Retrofit Q$25 per Fi�Aure
Center Pivot Irriaation Boom � $40
� VK
fiOUf
r Mile
TransfortnerS u t0 10 KVA �$70
Transformers over 10 KVA � $20
Transformers I Power Supply for Si9ns / Outline Lighting �$;
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Ir�cludes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Insoection Trips � $20
Fee
USE ONLY
TOTAL FEE
total fee is $20)
I hereby cerlity that I inspected the elecincel inslallation described herein on the dates stated:
ROUGNIN DAiE
FMIAI INSPECTqN x'/ � � E �
/ '" - . . -��� �
.��^ FOR OFFICE USE ONLY
I INIII IIIII NIII III� IIIII IIII � �"
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* 1 3965330* �L�
Reque Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-in: Ready Now ❑ Will Call
You must call the inspactor when readyl Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address�t, Bo� o��� Cily �'�V Zip Code �21
Secdon Township Range Fire No. Couniy
occu�Dl VIKRAM Prwne
Power Syppl�K � Address
+wc�
Electric�,��c�J�R�A-r'� Contractor LicA��eNuo�ee Master License Number
�.n wvo�
Mailing ��r��� (��� tio�N 55114
Authoriz nature (�trac • o an or Owner Pertortning Installatian) � Phone �j ���,�,�
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY