P - 77344' � REQUEST FOR ELECTRI�L INSPECTpIO� �'
� � � � � - 314 8❑ Minnesota Board of Electricity (��- �j�C.��
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 wwN�.eleclricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
E?CCEL EhIERGY SAVE�; ' S S�I I TCH
GENERALFEES
I POWER SUPPLIES
0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERAL FEES
iIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighling Retrofit @ $25 per Fixture
Center Pivot Irriqation Boom (� $40
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
Reinspection Fee $20
TOTALFEE �_ �,�,y
(minimum total fee is $20) 2 �
THIS AREA FOR iNSPECTOR USE ONLY
I hereby certiry that I inspected the elecUical installation described herein on the da�es stated:
RoucN�N onre
�INALINSPECiION . � � DATE f
oe - iaie ovnum nis ec;uwi tv ytv �. �+- — r-� v)
Special Inspection $30 P0f HOI1f exaiaeo;nanNOOr�eo oare
S cial lnspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
IIII II III II (�� II I�I II II� II III I� II) II (�I II III I III)
1 7 81, 3 1 4 8
'"�%� 1} f Q�t ', Rough-in Inspection Required? ❑ Yes �] No �I Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
�' II You must call the inspector when ready! ', Date Ready:
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I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
��°�`�`g ��.��T _ - __ _ _ _ _ --- c�ivFRIDLEY —
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Township j Section Range ; Fire No. County
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OW�r���pant�l�Iata�Y S I Please Provide Two (2) Phone Numbers Including Area Code
UL ly t'Ft�.. �I \ / \ /
i Electrical Utility �- ��- 'I! Electrical Utility Address —�
���i°F �.�`�'YG COf�F'OF�AT ------
�CCEI_ EhIEFiGY
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I C / I a� �ontractor L,iqg�se,N�upbR M Electrician or Power Limited Technici
LH tJtJSt3.:t LicenseNumber
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�� Maifng Address (Contractor. Company or Owner Performing Installation)
�'�Ot7 TER�;IT�?RI�L F�OAD, SAIMT F'AUL, I�hE 55ii�
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Au rized S' nature (Con[ractor or Owner Performing Installation) PI Pro i w Ph ne Numbers Includin Area Code
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INSTRUCTIONS ON BACK OF YELLOW COPV aonRn C�F Fi FcrRicirv cnav oo nnnn, e_,c o, .