P - 77389j REQUEST FOR ELECTRIC L INSPECT ON �
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� � ❑ Minnesota Board of Electricit Q�� `"� _
1821 University Avenue Suite S-128, Saint Paul, Minnesota Sb104
(651) 642-0800 TTY/MRS 1-800-627-3529 N�wiv.electricity.s9ate.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL �NEF:GY SAUEf;'S SWITCH
GENERAL FEES Outdoor Li hting Standard @$1
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 AmDere an $25 Suoolemental Fee an �20
tM, COMMUNICATION, REMOTE CONTROL, SIGNALING
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or ADDaratus a(� $.50
Each Additional Unit @
Li�hting Retrofit @ $.25 per Fixture
Center Pivot Irngation Boom @ $4C
Manufactured Home Park Lots (� $
Transformers over 10 KVA $ 20
Transformer I Power Supply for Signs I Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Insoection Trios (� $20
TOTALFEE
total fee is $20) �' S� ��
THIS AREP FOR INSPECTOR USE ONLY
that I inspected the elecMCal installation descnbed herein on the dates stated: �
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Special Inspection $.31 per Mile
TFFIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
J IIII II III I) I� II III II III II III II III II III II III I IIII
17813D49
I, ��f � L� �(� �j � Rough-in Inspection Required? ❑ Yes �] No II Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
� I, You must call Ihe inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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Section j Range
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i Electr�cal Utility I Electrical Utility Address
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� Mailing Address (Contractor, Company or Owner Performing Installation)
'��.:a0t? TEFiFiIT�RIAL FiGAD., St�ih€T F'A�JL, i*fM 5511�
—-————-__---_—_ __—__�_-- ——-
�I Authorized Si na�ntractor or Owner Performing Installation) �I Please Pi
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JSTRUCTIONS ON BACK OF VELLOW COPY BOARD OF ELECTRICITY COPv
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Master Electrician or Power Limited
License Number
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