P - 75761REQUEST FOR ELECTRICAL),I�N, P CTI N
1���� �� 3 2 6 2� Minnesota Board of Electricity OS(J�� ��� l _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mtt.us
Descril� -using the back of the white copy if necessa the work covered by this re uest:
E�sCryEL EWEFtGY SA�l�R'S SWITCN
GENERALFEES
0
AIARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unft
Retroffi aC1, $25 per Fixture
Traffic Sianal Standattl
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circu'rfs and Two InspecUon Trips Each Dwelling Unit @$80
ivirLLrtt ��•S� �
total fee is $201
I herebvi certitv that I inspecled the elecVical installadon da9cribed herein on the dat� steted:
7ai Inspection @ $.31 er Mile
NSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED W►ITHIN 12 MONTHS
IIII II III II lil II 111 I I III II I� II III IL I� II IH I II�
17813262
��}��/.� f Q�j Rough-in Inspection Required7 ❑Yes �] No Inspectlon Other Than Rough-In: �Ready Now ❑Witl Call
You must call the inspector when readyl Date Ready:
I certify�at I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
�°l�'i���i A�1E h1E °ih'FfiIDLEY
Township Sectlon Range Fire No. County
Owoer��t tde������ D Please Provide Two (Z) Phone Numbers Including Area Code
isC ti \ / \ �
Eledripl UtiNty Electrical Utility Address
XGEL ENERGY .
�Ut�il��Cl.�C CD�tiF'GFrATTOhI Contractorl.icense.Numbpc-. MasterElectricianorPovrerL'unftedTechnician
l, H U V tf tFJ U�nse Number
MalfinA AdSiress (Contractor, Company or Owner Perfortning Instailatlon)
2�44 TEfaF:TTOF:IAL Fi0F1Dq SAIhIi' F'AULq Mhl 55114
AuY��rized SI n�nUactor or Owner Perfartning Installation) ��Proyicj� Jwg.(71 �h,pne � mbers Including Area Code
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