P - 77394REQUEST FOR ELECTRIC�L IN P CTIg N �
1���J �� 3 61 9 Minnesota Board of Electricity ��- ��8!> f `�eµ� '
❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 - -
� (651) 642-0800 TTY/MRS 1-800-627-3529 x��ti�.e[eclricity.slale.mn.us
Descnbe -using the back of the white copy if necessary - the work covered by ihis request
EXCE� ENERGY SAVE(;`S 54S�T�.H
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 Ampere @$25 Supplemental Fee @$20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CII�CUITS I FEEDERS Transformer I Power Su I for Si ns I Outline Li htin $5
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, Ail
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20
Each System Device or Apparatus @$.50 Investigative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee @$20
tdULTIFAMILY DWELLINGS PER UNIT TOTAL FEE ��-� ,�,
3 to t2 Units @$5o Per Unit (minimum total fee is $20)
Li htin Retrofit �$.25 pef Fixtufe I hereby certify that I inspected the electrical installation described herein on the dates stated:
Center Pivot Irri ation Boom @$40 Ro�c� �N onre
Manufactured Home Park Lots $25
Recreetional Vehicle Park Sites $5 Fwn�iNSPecrioN _ oaTe
Se arateBondin Ins ection $20 ��a'O�
Sp2Ciel If1SpECtiOf� @$30 pBf HOUf ExaiReo nenNOONeo onre
Special Ins ection @$.31 per Mile
THIS INSTALIATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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I IIII II III II I� II lil il IN II III II III II III II II I IIII
1 7 8 1 3 6 L 9
%"% + � ��, Rough-in Inspection Required? ❑Yes No '�� Inspection OtherThan Rough-In: Ready Now �Will Call
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. You must call the inspector when ready! I Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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�op��tel�t�ee��fe�T NE---- - -- ___ -___-_ _ c�ryFfiIDLEY
Township i Section ��. Range Fire No. � Cou�ty ANO KA
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OWpBr(Q�rt pldrp����� � Please Provide Two (2) Phone Numbers Including Area Code
Wt}l� l�H � ` � �
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Electrical Utility Electrical Utility Address
; xcE� EhIE�GY
��-Contractor nse � Master Electrician or Power Limited Technician
i��`����`�'����C CQfiF'OFiATION �A {��`�'�J LicenseNumber
�� Mailing Address (Contrector, Company or Owner Performing Installation) � �
�30C� TE�;FiITOf;TAL ROAD, SAIhlT F'AUL, hth! 55114
Authonzed Si nature (Contractor or Owner Performing Installation) i pl Pro i Two,� Ph ne Numbers Including Area Code
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INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF EI.ECTRICITY COPY EB-00001A-15 8.1. 2004