P - 77397REQUEST FOR ELECTRICAL INSPE T QN �
1�� 8 1� 3 O 9 H� Minnesota Board of Electricity �QD�'���j�s ;�-. -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �: ;
(651) 642-0800 TTY/MRS 1-800-6273529 www.electricfty.stute.mn.us
Descnbe -using the back of the white copy if necessary^ the work covered by this re uest:
EXC�L EMEf�GY S�iV�Fi ' S SW:[ TCH
GENERALFEES
I SERVICES/
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus (� $.50
ADDITIONS TO THE GENERAL FEES
iIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit (�a $.25 per Fixture
5
Traffic
1
Standard @ $5
Fee @ $20
uototOKVA(�$1
� Transformer I Power Supply for Signs I Outline lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Indudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiqative Fee
TOTAL FEE ��
minimum total fee is $20) �%• 5�
I inspected the electrical installation described herein on the dates stated:
S arate Bondin Ins ection $20 �-2� -�'J
Special Inspeetion @$30 per Hour exPieec aenmooneo oare
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
IIN II I� II III II I� II ili I I III I I�I I I III I I I I I I III I
17813098
I� ��yL j}�Q � �I Rough-in Inspection Required? ❑ Yes �] No �'� Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
,. �'� 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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� ����� L�'�I�LN S7' , FRIDLEY
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�I �N�����am�u���� � � Please Provide Two (2) Phone Numbers Including Area Code
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i, Electricaf Utility I Electrical Utility Address -
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�dJMI/CtL�l..t��� ea�E'OFiATIOhI �contractor�gnsejJy,rr�p�� sterElectricianorPowerLimitedTechnician
H t}Uti ..� License Number
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�Mailing Address (Contractor, Company or Owner Performing Installatwn)
L:�00 TEf:RITOF;I�t_ ftOAA, SAINT F'AUL, !�N 55114
Aathorized Signature (Contractor or Owner Performing Inslallation) Please Provide Two�2 Phone Numbers
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INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY �
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