P - 77347REQUEST FOR ELECTRICAL INSPECTION ���
1� 7��- 311 4❑ Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 wx�i��.electricitystate.mn.us
Describe •using the back of the white copy if necessary - the work covered by this request: �/'Ii"')�� v
�xCEL EhlE�;GY Sak�EFi � S sw�rcw ��
GENERALFEES
SERVICES / POWER SUPPLIES
r 0 to 400 Ampere (cil $25
I ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
� CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
r fach Svstem Device or Apparatus (cil $.50
Unit
Additional Unit @
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriqation Boom an $40
Outdoor LiQhtina Standard
Supplemental Fee @ $20
Transformers u 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 andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
TOTALFEE
total fee is $20) 2-� �S � �
that I inspected lhe eleclncal installa�ion descnbed herein on ihe dates stated:
___.._ _. _. _ .�
Se arate Bondin Ins ection $20 �_�--�_- — Z� �
SpeCiel IfISp¢ction $30 p2f HOUf exaiaeo aanr�oo oare
S ecial Jnspection $.31 per Mile
THl$ INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
IIII IIIII II� III� II�I II�II II III II� IIIII IIIII
17813114
^l� f fJ C � Rough-in Inspection Required? ❑ Yes �] No � Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
� You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
_ — _ _ _ _ — - --___
Jo Si S . . _. .�ity-
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���b �Bi`1�P� ST I�E FRIDLEY
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Township �Section � Range i Fire No. County (3-��
Ii OW[�rlOc�c-up -antNa�qe -i S��.,.. � � -� ���- ��lease Provide T o(2) Phone Numbers Including Area Code
l�"'Kat'ftJVlt� / \
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' Electrical Utility I Electrical Utility Address
'i KCE� EhIE�.GY i----
C / i Contractor se �� Master Electrician or Power Limited Techni
' �F�°� �'�.��''gc eo�F�n�arzar� `�' d't��� ! ���e�se N�mbe�
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Mailing Address (Conhactor, Company or Owner Performing Installation)
I�,:�rJO TERI"iITOF{IAL i"iOAD� S6iIhlT F'AULi i*IN 55114
F__-- -- _ _ T - - - -- __
I Authorized Si nature (Contractor or Owner Performing Installation) PI � Pro i w Ph ne Numbers Including Area Code
I ��4r� �.� ��� ��if ( )
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