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P - 773871 REQUEST FOR ELECTRIC L INSPECTION �� J., �-� � � - 3 4 7 8� Minnesota Board of Electricity �, �O�-/'� ���4 ;�-. _ _ :�'; 1821 University Avenue Suite S-128, Saint Paul, Minn�sota 55104 (651) 642-0800 TTY/MRS 1-800-627-3529 wN�w.electricitv.state.mn.us Describe -using the back of the white copy if necessary - the work covered by this request: EXCEL �NE�GY SAVEF:'S SWITCH GENERAL FEES Outdoor Lighting Standard @$1 SERVICES I POWER SUPPLIES Traffic Signal Standard @$5 0 to 400 Ampere (� $25 Sunnlemental Fea n R90 iM, COMMUNICATION, REMOTE CONTROL, UITS, CIRCUITS OF LESS THAN 50 VOLTS Each System Device or Apparatus @$.50 ADDITIONS TO THE GENERAL F fIFAMILY DWELLINGS (PER UNIT) 3 to 12 Units @$50 Per Unit Each Additional Unit Q $25 OTHER ADDITIONAL FEES Lighting Retroft @ $.25 per Fixture CeMer Pivot Imgatlon Boom @ $40 Manufactured Home Park Lots lc� $25 � Transformer I Power Supply for Signs I Outline Li htin $5 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 Unit @$80 Fee TOTALFEE total fee is $20) a�•Sa �''� I hereby certify that I inspected the electrical installation described herein on the dates stated: (1 -- _,.lc-�.---t (`. Z-�—�� Special Inspection @ $.31 per Mile THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS IIII II III II I� II Ill !I II� I I III II I I I II Iil II IN I III I 17813478 iL�/(� �j i Rough-in Inspection Required? ❑Yes �] No I�, Inspection Other Than Rough-In: [�Ready Now OWill Call �''� You must call the insoector when readvi I narP aPan��� I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: ----- - —. ___ _— _ _ — — — _ _ _— — — __ _ - -- ��o��t��tree�q�`�sAt�E hIE: ��Y�fiIDLEY I� Township , Section i Range �I Fire No. County � (� ��'F'F�f" �'�GN T I Please Provide Two (2) Phone Numbers Including Area I\ � \ � '�. r�ecuicai unury I Electrical Utility Address �� ��� ; xc�� ENERGY � IC�qty�c�Cp�par}y��g —�-- f1UM1/ tLti�11'C1G ���tiF'QFtiATIC7I�I TContractorl,icanse,(Jy�rpb�{.� MasterElectricianorPowerLimitedl l.H llVtfi3J !LicenseNumber I � I �L_ _.---�-- — ---- -- �— — - — ---- -- -- -- - - L.._—_— -- Mailing Address (Contractor, Company or Owner Performing Installation) I��Oa TE��ITt7�I�i.. Rt7AD, S�IhiT F'AUL, hih! 551i� I Authorizetl Si nature (Contractor or Owner Performing Installation) � PI as Pro i w Ph ne Numbers Includin Area � �„��� !��,� ���-���� � � 9 �--- INSTRUCTIONS ON BACK OF YELLOW COPV BOnRD oF F� FcrRicirv cnav � .. .......... ..