P - 77392REQUEST FOR ELECTRICAL INSPECTIQN F�
1� 7 81- 3 6 2 7� Minnesota Board of Electricity ���� p%� y
� 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
i�:
� (651) 642-0800 TTY/MRS 1-800-627-3529 winx�.electricity.sfate.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request
EXCE� ENEF:GY SAVEF;'S SWITCH
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Tra�c Sianal Standard fa� $5
0 ta 400
401 to 8
,LARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
;IRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
3 to
Unit @
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriqafion Boom na $4(
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer / Power Supply for Signs / Outline Lighting @$5
ONE & 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 Inspection Trios (a� $20
TOTAL FEE I,� � �� ,�,�
minimum total fee is $201 lot
I inspected ihe electrical installation described herein on the dates stated:
� 30�-o i I
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
IIII II I� II III II III II III II III II III II �i II I� I Ilf �
1 7 8 1 3 6 2 7
!"�/ j?L} l{) 5 '� Rough-in Inspection Required? ❑Yes �] No �i Inspection Other Than Rough-In: [j�Ready Now ❑Will Call
i
j ; You must call the inspector when ready! I 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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I Iowrtship I Section i Range I
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°�i'%��`L`.C.a�'e KAFiLA F; I
F'lease Provltle Two (2) Phone Numbers Including Area Code
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i XCE� ENERGY
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��,C�'I{JMi/ G:..CC.1!'C1C GOkF�,!'�iajT�i'`E 'Contrecrorl,i��nse,Nytrqbp{J MasterElectricianorPowerLimitedTechni�
l, 11t1tits LicenseNumber
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I Mailing Address (Contractor, Company or Owner Performing Installation)
���0 TEf;RITOF�IAL f;CIAiJ, S�,INi F'AUL, f�N 55114
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i Authorized Si nature (Coniractor or Owner Performing Installation) I PI Pro i w Ph ne Numbers Including Area Code
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