P - 76266• f�EQI�EST FOR ELECTRICAL INSPECTION
1���� - 5 2 2� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' _ — ' . (651) 64�2-OS00 TT`f/MRS 1-800-627-3529 www.electricity.stade.mn.us
Describe -using tMe back of the white copy'rf necessary - the work covered by this request:
EXCEL EhlEfiCa� Sf��E�i ' S^�?l I TGN
GENERAL FEES Outdoor Liqhtinq Standard na. $1
710N, REMOTE CANTROL,
OF LESS THAN 50 VOLTS
to 72 Units @$50 Per Unit
ach Addi�onal Unit @ $25
OTHER AD
Sites
HIS IAISTALLATION MAY BE ORDERED DISC�
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975228
Transfortners u to 10 KVA $90
Transformers over 10 KVA @$ 20
Transformer / Power Supply for Signs / OuUine LighUng @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amper�, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
total fee is $20) � �° `'{�
I inspected the electrical insfsllation d�cribed herein on Ne dat� statetl: I
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�MPLETED WITHIN 12 MONTHS________�
I�C'D JUN 14 �,
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va[q: Rough-in Inspection Requfred7 ❑Yes �] No Inspection Other Than Rough-In: [�Ready Now �Will Call
� f�. �. r�17 You must call the inspector when readyl Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecfical work at
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Electrical Utllity
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Piease Provide Two (2) Phone Numbers I
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wnerac�or i �ampany rvame conVactor ucense Number Master Electrician or Power
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AAaqing Address (Contractor, Company or Owner Performing Installation)
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A4t�tollzed $ignature (Contractor or Owner Performing Installation) Piease Provide Two (2) Phone Numbers Incluc
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