P - 76375REQUEST FOR ELECTRICAL INSPECTION ���`�`�'k ,
2� 0 2 4� 516 � Minnesota Board of Electricity <�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
C,�a (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us !��
Desc ' ing the b�k-of th hi e copy if necessary - the work covered by this request:
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G L FEES Outdoor Li hting Standard @$1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Amoere a(� $25 _ Supplemental Fee @$20
Above 200 Am ere a$10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS Of LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus an $.50
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIO
Liqhtinq Retrofit (a2 $.25 per Fi#ure
Special Inspection a$30 per Hour
Special Inspection $.31 r Mile
THIS INSTALLATION MAY BE ORDERED [
I IIII II III I I��I I I III II � �� II II I II III II III ��I I�I
? 0 2 4 5 1 6 3
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs I Outline Lighting @$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
Fee
TOTAL FEE h 5U
total fee is $20) ,�1��
I hereby certify that I inspeded Me elechical inslalla6on described herein on the dates stated:
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ONNECTED IF NOT COMPLETED WITHIN 12 MONTHS__�_ __�
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Date: Rough-in Inspection Required? ❑ Yes �fJo Inspedion Other Than Rough-In: ❑ Ready Now� Will Call
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You must call the inspector when ready! ` Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job te Street Address City
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Township Section Range Fire No. Coun
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�er/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
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Electncal Utility - Elec
Centerpoint Ene g)
Contrador / Cor�9�8 en �
Anoka, MN 55304
mascer eiecmcian or
License Number
or ai n) Niease Nrowae i wo (z) Nhone rvumbers i
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