P - 75762� REQUEST FOR ELECryRI�QA�I,j� �E�TI�N
1�� v"� - 3 2 5 4� Minnesota Board of Electrici p�� J y ;
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 ivww.electricity.state.mn.us
Descdhe -using the back of the white copy 'rf necessary - the work covered by this request
EXCEL EI�EhGY SAVEF: ' S�r,l I TCH
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 Ampere (a� $25 Supplemental Fee @$20
IMMUNICATIQN, REMOTE CANTROL
CIRCUITS OF LESS THAN 50 VOLTS
ivstem Device or Apparetus a�. $.50
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs I OutBne Lightlng @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, AII
Circuits and Two Inspection Trips Each Dweliing Unft @$80
Fee
Each
Unit @
� Retrofit $25 per Fixture I hereby certity thet I
Pivot Irzi ation Boom @$40 0.0Utl11N
ctured Home Park Lots $25
tlonal Vehlcle Park Sftes $5 Fiw� wsvecnau
te Bondin Ins 'on $20
Ins�ction @ $30 per Hour °�°'"B"N00N�
Ins ti�n @ $.31 per Mile
iTALLATION MAY BE ORDERED DISCONNECTED IF NO
_ 11� II f� II I� 11111111111111111111 � 1N ll lll l lll)
17813254
TOTAL FEE
total fee is $20) � •�� �
the electrical installation described hereln on the dates stated:
'LETED WITHIN 12 MONTHS
��`(� jo �j Rough-in Inspec6on Required? ❑ Yes �] No Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
You must call the inspector when readyl Date Ready:
I certiiy that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at