P - 77346REQUEST FOR ELECTRICAL IN}� EC ION �
1#7� 81- 312 2 Minnesota Board of Electricity a(��J 'b/�i � ,�
❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.eleclricity.state.mn.us
Describe -using the back of the white copy if necessa the work covered by this re uest:
EXC�L ENEF�GY SAU�R'S St�I�CH
GENERAL FEES Outdoor Liahtina Standard C� $1
CES I POWER SUPPLIES
to 400 Amcere fa� $25
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus (� $.50
Each Additional Unit @
� Retrofit @ $.25 per Fixture
Pivot Irriqation Boom (la $4(
Traffic Signal Standard $5
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 & 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 Ins ection Tri s $20
Investigative Fee
Reins ection Fee $20
TOTALFEE �'S.Q�
(minimum total fee is $20)
THIS AREA FOR INSPECTOR USE ONLV
I hereby certify that I inspected the electrical installation described herein on the dates stated:
ROUGHIN DATE
FINALINSPECTION DATE
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Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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��. D��^�ra� ��I Rough-in Inspection Required? ❑Yes �r]No I Inspection OtherThan Rough-In: [�Ready Now ❑Will Call
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', You must call the inspector when ready! Date Ready:
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I certrfy that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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�, Electrical Utility '�. Electrical Utility Address
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', Cqr�(ra��/ C,p,�qyrjX j�,�n� � Cp�� �� �T ��� � � Contractor �e.�nse jJ�rt�¢g�� i Master Electrician or Power Limited Technician I
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. Madmg Address (Contractor, Company or Owner Performing Installatwn)
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rutborized Signature (Contrector or Owner Performing� Installation) TPlease Provide Two (2 Phone Numbers Including Area Code
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