P - 77338REQUEST FOR ELECTRICQL INSPECTION F
1����-� 7 6 7 Minnesota Board of Electricity fl{D�� �t�� '�
- 1821 University Avenue Suite S-128, Saint Paul, Min so 4 '� '
(651) 642-080� TTY/MRS 1-800-627-3529 H�ir�a�.electricity.s�ale.mn.us
Descnbe -using the back of the white copy if necessary - the work covered by this request:
EXI:EL EhiEfiGY SAVEf;'S SWITCN
I POWER SUPPLIES
to
Above 200 Am ere �$10
AtARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit @
Retroft @ $.25 per Fixture
ivot IrriQation Boom (� $4(
Traffic Signal Standard
Supplemental Fee @ $
Transformers up to 10
Transformers over 10 f
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investigative Fee
Reinsqection Fee (�a $20
TOTALfEE
total fee is $20) �' S� �
1 inspected the electrical installation descnbed herein on the dates stated:
�'1'�1
Special Ins ction $.31 per Mile
TH1S INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
IIII-II II� I) I� II III II II� �I ( I II II) (I III II I� I II�
17813767
�'�, ��f � L} l(1 �} I Rough-in Inspection Required? ❑ Yes � No I, Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
�� �� You must call the inspector when ready! 1Date Ready:
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I Certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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�J°�.,`�i��` �`�iLIh! CIF S a�vFf:I17LEY
!��`�1`�F�iN�'�-iFiISTOF'FIEfti D I -L_ __ I��leasej
i Electrical U51ity Electrical Utility Address
i xc�� �r�E���r
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Jumbers Including Area
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�C4t�Ul4������� i�C �Q�i�'O�tiATIOI�I Contractor�nse,[v�rpp��. IMasterElectricianor
4� t� J License Number
II
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! Mailing Address (Contractor, Company or Owner Performing Installation)
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I�:itit? TEfifiITOFiIAL �iOAD, SAIHT F'AUL, MN 551i4
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j Authorized SiQnature (Conhactor or Owner Performing Installation) - I Please f
Jumbers Including Area
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