P - 79333' ❑ REQUEST FOR ELECTRICAL INSPECTION
� r 1 1�- 6 01 `�' S121 UnrvtersBy Ave �ue 8u terS!128, Saint Paui, Minnesota 55104 -
� (651) 642-0800 lTY/M RS 1-800-627-3529 www. electnciry.state. mn. us
] ADDITION 0 REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
:�GEL ENEF?GY SAVER'S SV},'ITCH
GENERAL FEES Outdoor Lighting Standard @$1
'LIES Traffic Sianal Standard na $5
Q to 4Q� A�
401 to 800
Transformers over 10 4CVA $ 20
Transformer / Power Suppty for Signs / Outli�e Lighting �a,l $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, Ali
Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS Of LESS THAN 50 VOLTS
Unit (minimum total fee is $20) � �1Cl,bU
in5 iH15 AREA FIXt INSPECTIXt USE CfIY
� I hereby certiry Nat I inspeded the electrical insfalla6on described herein on the dates staled:
t ADDITIONAL FEES
��F�Xt�� � c� y - �J &i3
Center Pivot Irri ation Boom $40 '""'"'"
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 "W'` "'�`
Se arate Bondin ins 6on $20
S ial Ins tion $30 r Hour E"""ED'"
S ial Ins ction $.31 r Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTE�
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Request Dffie: Rough-in Inspection Required? ❑ Yes ❑�Flo Inspection Other Than Rargh-In: ❑i�ady Now ❑ Will Call
�gf ��� You must call the inspectw wFien ready! Date Ready:
I certiy that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tt�e electrical work at::
INSTRUCTONB ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPV EB-0OOO1M14 8.1. 2W2