P - 77390�-781-333 �8
REQUEST FOR ELECTRIC INSPECTION �
Minnesota Board of Electricity O�� D/�9� '
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55 4
;�:
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if ne�e�� t�he
GENERALFEES
SERVICES I POWER SUPPLIES
0 to 400 Ampere @ $25
401 to 800 Am re $50
Above 800 Am re $75
CIRCUITS I FEEDERS
0 to 200 Am ere 35
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNAL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULT�FAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liphting Retrofit na $.25 per Fixture
S SWITCH
Traffic Signal Standard
Supplemental Fee @ $
Transformers up to 10 I
Transformers over 10 N
Transformer / Power Su I for Si ns / 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
Additional Ins ection Tri s $20
Irnestigative Fee
Reinspection Fee @ $20
TOTALFEE
(minimum total fee is $20) ZV'�d
iHIS AREA fOR INSPECTOR USE ONIV
I hereby certify ihat I inspected the electrical installation described herein on the dates stated:
KBCfB2t10081 V2fiICIB F'afK 51I2S N y5 �'""""'""'""" , o^TE �
Se rate Bondin Ins ection $20 �/� z-Y� r'S
Special Inspection @$30 per Hour exPiaeo naa�+oo�eo oaTe
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
IIII II� II�� III�I II� IIIII IIIII �III IIIII IIIII
178L3338
�� ��% G�{f � 5 ��.� Rough-in Inspection Required? ❑ Yes �] No i Inspection Other Than Rough-In: [�Ready Now �Will Call
j I You must call the inspector when ready! ' Date Ready:
I certrfy that I am the C�] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
�°� �'f � ''3�'8`9�1 AVE _ _—_ _ ._ _ __ - - - Y - --- -_ --
- c�t FRIDLEY
�, Townshi�-- p— � Section I Range '� Fire No� ounty .
��.�%��i� ����F�� � �'(-- ---__L_ ._. -- - 1___—__ - _ _Please Provide T�I_..._ .—_ _ _---
O e � � 1, wo (2) Phone Numbers Including Area Code
\ / \
iEledrical Utility Electrical Utility Address � -
XCEL EhIEF;GY
IC��a('���F�?�9'��C ���F�����1�� � � 'iContractorl�e�s��� MasterElectricianorPowerLimitedl
I I License Number
�
-- --- — ----- —._ _.. _. . ._ ,. _ ..—
� Mailing Address (Contractor, Company or Owner Perfo{ar �n� �Tall �o�n�� q �� c' Cf � 1�
�.�oo T��:�zzc,�r��. �a�n,
-- — _ . —
,� Ay�prized ' tu e(Contracror or Owner Performing Installation) I�I�as�q Pro�ri��7woj� F�hfne �
� �F �
---- - --_. — -- --
INSTRUCTI^�S C^BACK OF YFLLl�1 C'�°V _ BOARD OF ELECTRIGTY COPV
/
/
EB-00001A-15 B.L 2004