P - 77333REQUEST FOR ELECTRIC�4L INSPECTION
1"�� � O�- 3 2 4 7� Minnesota Board of Electricity O �D S ����
1821 University Avenue Suite S-128, Saint�ul, Mi� soia 55104
the
GENE
1 to 800
(651) 642-0800 TTY/MRS 1-800-627-3529 �a�wtir.electricitv.slate.mn.us
copy if necessa the work covered by this re uest
E?fC�L EhIERGY SA4'�F:'S S1�ITCH
RAL FEES Outdoor Lighting Standard @$1
Traffic Signal Standard @ $5
Su�olemental Fee na $20
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Center Pivot Irrigation Boom @
Manufadured Home Park Lots I
Recreational Vehicle Park Sites
Hour
j Transformer I Power Supply for Signs I Outline Lighting @$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 Inspection Trips @ $20
Investiaative Fee
TOTAL FEE I 2aSQ �
(minimum total fee is $20)
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that I inspected the elecirical installation described herein on the dates stated:
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
I IIII II III II II) II �II II III N III II III ��I II I� I II�
178L3247
���. '"`�j y^�,1� f(� 5 ' Rough-in Inspection Required? LJ Yes �J No I, Inspection Other Than Rough-In: j�Ready Now ❑ Will Call
I . You must call the inspector when ready! � Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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! Please I
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County ��
Two (2) Phone Numbers
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'�. Electrical Utility � Electrical Utility Address
i XCFL Eh1EF.GY
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�� C / C , Contractor ense f Master Electrician or Power Limited Technician
: �`��°�' �°'C`�i�i'�C CDfiF'OfiATIQhI ; �A (��i���i �LicenseNumber
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Mailing Address (Contractor, Company or Owner Performing Installation) - ,
L'�04 TEF�hITLIF�IAL ROAD, SAINT F'AULS h1hE 55114 �
— - _ _ -- _ . _ � _ - --- �
�Authorized Signatur�ntractor or Owner Performing Installation) �-I-Please Provide Two�2 Phone Numbers Including Area Code
� +� !'� --- --- - I (d5]� 646-��ii � �
INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY Pa_nnmm�_�s a� �nna