P - 773801 REQUEST FOR ELECTRICAL INSPECTION
1���1- 3 6 5 0❑ Minnesota Board of Electricity �/'y�C����� �;-
, 1821 University Avenue Suite S-128, i4t'aa�7i n sot 104
(651) 642-0800 TTY/MRS 1-800-627-3529 w�ti��.electricitystate.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCE� ENEF�GY SAVE�`S SWITCH
GENERAL FEES Outdoor Li hting Standard @$1
SERVICES I POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 Ampere $25 Supplemental Fee @$20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I Power Su I for Si ns I Outline Li htin $5
O l0 200 Am ere $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20
Each Svstem Device or AooaraWS C� $.50 Investiaative Fee
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liqhtinq Retrofit al� $.25 per Fixture
TOTAL FEE I^ O �� ��
total fee is $20) �C
I inspected the electrical installation descnbed herein on the dates stated:
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arate Bondin Ins ection $20 ...�- �=-- ��--� ' s T- c)
S cial Inspection @$30 per Hour exP�Reo Asn onre
S ial Inspection @$.31 per Mile
CHI$ HJSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
i IIN II III II �I II lil II III II III II III N NI II �I I Illf
17813650
� ��,"�(��(� �j II Rough-in Inspection Required? ❑Yes �] No �I Inspection Other Than Rough-In: [�Ready Now ❑Will Call
s:.
�. � i You must call the inspector when ready! I Date Ready:
I I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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��'°��c�?�`�Bi`t�`�L�Y ST NE: rc��rFhIDL�Y
! Towrtship
'I WI-�l��a���� E L F�
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Section , Range j Fire No. County ��y� Kfl
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�Please Provide Two (2) Phone Numbers
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� xcE� E��r��Y
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�I Cqq( ��/ Gornpar�y�L�G �G���O��.r.I �� �Contractor t,i�e„nse,[J}{rp�ip{� Master Electrician or Power Limited Technician
�••i��rt t�ti, � �;� t,� v��t�rs,.a ILicenseNumber
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i Mailing Address (Contractor, Company or Owner Performing Installation)
i �304 TEFRITt�F,IAL Rt�AD, SAINT F'AUL, �fh! 551i4
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Authorized Si nature (Contractor or Owner Performing Installation) I PI � Pro i w Ph ne Numbers Including Area Code
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