P - 77366REQUEST FOR ELECTRICAL INSPECTION '
1�� O�� 3 4 3 7 Minnesota Board of Electricity �� �_ '
� ❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 x ti+�titi�.electr�ciry.state.mn.us
the back of the white copy if necessary - the work covered by this request:
Exc�:�. �.���G�r saw���s �wi�-{v�
GENERAL FEES Outdoor Li hting Standard @$1
IWER SUPPLIES Traffic Signal Standard @$5
npere @ $25 Suppiemental Fee @ $20
Amoere (�a �50 Transformers u� to 10 KVA an $10
Above 800 Am ere $75 __L
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CJRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liqhtinq Retrofit (� $.25 per Fixture
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unil @$80
Additional Inspection Trips @ $20
Investiqative Fee
w
i�in�ret ��,
total fee is $20) °�'SD
that I insoected the electrical installation described herein on the dates stated:
rtecreeuonai veniue rarrc aues w �� ... _.._. _- .-.. . � - ,--,
Se arate Bondin Ins ction $20 � Li ��
Special Inspection $30 pef HOU� exviReo;aear�ooNeo oare
Special Ins ection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
I IIII II II) II I� II III II III (I III II III II III II I� I II�
1781343?
��.:, ��f iL��� � 'I Rough-in Inspection Required? ❑Yes j�] No �� Inspection Other Than Rough-In: [j�Ready Now ❑Will Call
� � 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:
,�"�u�'��1Te�i�`f�SAVE h!E c�tv��IDLEY
�
iTownship
' ��`N�a�C�'� N E � J
Section I Range
Fire No. I County HNU 1� ia
Please Provide Two (2) Phone Numbers Including Area Code
� � � �
i EIecVICaI Utlhty tlectrlCal Utllrty Atltlress
xcE� ENE�GY �
- _ --- - _ _ —�
— --- -
� C r / T i, Contrector s I Master Electncian or Power Limited Techni
,��` ���'��i`�'iC COF:F'OFiATs ON �� �+� I License Number
_ ._-_- —_. . ._ --- --... — _- _ __- — —.._ �--
Mailing Address (Contractor, Company or Owner Performing Installation)
�30C3 TER4ITOf;I�L. ROAD, SA3'NT F'A►JL, i�hf 55114
�- -- _ -- -- — -- - - - -
Au rized S' na;�ontractor or Owner Performing Installation) � I P��s�Proyide�Two.(2� ehone � mbers Including Area Code
'� b�f Y i i j
iuerouer�nue nu aerr nc vci � nw enev � � anaan nr Fi crTainrv rnov ra_nnnn� n_�s a�