P - 77747REQUEST FOR ELECTRICAL INSPECTION
1���.!.- 3 5 6 7� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricitv.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL EhIERGY SAVER'S S�lITCH
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPLIES Traffic Siqnal Standard (a� $5
CIRCUITS / FEEDERS
0 to 200 Ampere @$5 T
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERAL FEES
WELLINGS (PER UNITI
3 to 12 Units @$50 Per Unit
Center Pivot Irrigation Boom
Manufactured Home Park Lc
Recreational Vehide Park Si
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs 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
ion Fee @ $20
TOTAL
minimum total fee is ;
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0
the eiectrical installation described herein on the dates stated:
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Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
I IIII II II) II I�� II III II (II II III II III II III II I� I(I�
17753567
2!�/LGQS
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Rough-in Inspection Required? ❑ Yes � No I� Inspection Other Than Rough-In: � Ready Now OWill Call
You must call the inspector when ready! I Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER
i Job Site Street Address
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�11�1 LYt�iDE DR NE
CGLtiTil: DdhllhfIC
and hereby request inspection of the electrical work at:
-- City ------
Ff;IDLEY
Fire No. County
i-I �i Q i{ 19
Please Provide Two (2) Phone Numbers Including Area Code
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I tiec[ncai u[urty I Electrical Utility Address ��
' ?CC�� ENEfiGY i
I Contractor / Company Name � ��, Coniractor License Number i Master Electrician or Power Limited Technic
'� '�� License Number
' HUh1T EL�CTfiIC CORF'ORATION CA O�J883 _1 _
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; Mailing Address (Contractor, Company or Owner Performing Installation) �
j L,i40 TE�iRITOf;IAL FtOAD, SAINT F'AUL, C'ihl 5511�
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rAuthorized Signature (Contractor oi Owner Performing Installation) �Please Provide Two (2) Phone Numbers Including Area Code
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