P - 77374c� REQUEST FOR ELECTRICAL I PECTION
1 a 7 8 1� 3 U 6 a Minnesota Board of Electricity ��L7� d]� `'�' `_ `
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1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricitv.state.mn.us
Describe -using the back of the white copy if necessa the work covered by this request:
�XC�L �hiERGY SAV�R'S S4JITCH
GENERAL FEES Outdoor Liqhtinq Standard (cil $1
SERVICES I POWER SUPPLIES Traffic Sinnal Standarri n�5
� 401 to 800 Ampere @$50
� Above 800 Ampere $75
CIRCUITS / FEEDERS
0 to 200 Ampere a�, $5
� Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL;
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FI
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
EachAdditionai Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $25 per Fixture
Center Pivot Irrigation Boom @ $40
�DAanufactured Home Park Lots (� �25
Supplemental Fee @ $20
Transformers up to 10 KVA @$10
Transformers over 10 KVA @$ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE 8 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
ction Fee $20
TOTAL FEE ,z,�,�
(minimum total fee is $20) � • �
�HIS AREA FOR INSPECTOR USE ONLY
that I inspected the electrical installation described herein on the dates stated:
onre
oaTE
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specia� Inspection � g30 per Hour exaiaeo asaNOONec oATE
Spedal Inspection @ $.31 per Mile
THlS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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�, ����(�{Qrj �, Rough-in Inspec[ion Required? ❑Yes �] No �'I Inspection OtherThan Rough-In: [�Ready Now ❑Will Call
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' _I, You must call the inspector when ready! 1 Date Ready:
I ceRify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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i J y�tzS�re l.tl4 ! Ith'3L f�4,�� �� i City _--
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FRZi�LEY
��, Township Section I Range I Fire No. ii County A��+�� �
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� Ov�r�-r(9�,c��t t�ay,n�E� `T Please Provide Two (2) Phone Ni
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Electrical Utildy �— E ctrical Utility Address �
! XCEL �NEFtGY
� HUNT ELEG�T�iIC CQftF'[JRAi -------�
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Conhactor / Compan Name�� Contractor License Number Master Electrician or Power Limited 1
I Ia�i �, C�} {�Q�BJ ILicenseNumber
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I Mailing Address (Conhac[or, Company or Owner Performing Installation)
' �3�J{i TERRTTO�iIAL FiOAD, SAINT F'AULq 1'1N 55114
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j Authorized Signature (Contractor or Owner Performing Installation) - rPlease Provide Two (2 Phone Numbers Including Area
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Area
INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICIN COPV �