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:
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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:
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I Please Provide Two (2) Phone Numbers Including Area
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'�. r�ecuicai unury I Electrical Utility Address �� ���
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l.H llVtfi3J !LicenseNumber
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Mailing Address (Contractor, Company or Owner Performing Installation)
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I Authorizetl Si nature (Contractor or Owner Performing Installation) � PI as Pro i w Ph ne Numbers Includin Area
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INSTRUCTIONS ON BACK OF YELLOW COPV BOnRD oF F� FcrRicirv cnav � .. .......... ..