P - 77402REQUEST FOR ELECTRICAL INSPECTION �
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❑ Minnesota Board of E�ectricit ���—U���� "°� ;d'.
1821 University Avenue Suite S-128, Saint aul, Minnesota 5104
(651) 642-OS00 TTY/MRS 1-800-627-3529 wN�w.eleclriciry�state.mn.�,s
DeSCnbe -using the back of the white copy if necessary - the work covered by this requesY,
�XCEL �NEf;GY SAVE�'S SWITCH
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 Ampere na $25 Suoolemental Fee (� $20
� B00
I FEI
� Above 200 Ampere @$10 �
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Ml3LTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Irrigation Boom @
i Home Park Lots I
Vehicle Park Sites
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer / Power Supply for Signs / Outline Lighting @$5
ONE 8 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
Fee
TOTAL FEE � ��
total fee is $20) `'
I inspected the electrical installation described herein on the dates stated:
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Special Ins ection @$.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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'i "$'f ��t� f f� �j !i Rough-in Inspection Required? ❑ Yes �] No I Inspection Other Than Rough-In: [�Ready Now � Will Call
� You must call the inspector when ready! I Date Ready:
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I ceRify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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! Range I Fire No. I County
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Please Provide Two (2) Phone Numbers
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t"I��yi/ k.Ltl.l��.. ! ���'OfiATTON IContractorf,i�nse:[Jxrppy{� iMasterElectricianorPowerLimitedT
i � Ft U V t3rsJ License Number
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Mailing Address (Contractor, Company or Owner Performing Installation)
I�300 TEF�RITOE'IAL. F�dAl7, SAIhIT F'AUL, �IN 55j.14
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Authorized Si nature (Contractor or Owner Performing Installation) �I i,se Pr �cj.e�Two^(� i�ne Numbers Including Area
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INSTRUCTIONS ON BACK OF YE�LOW COPY BOAR� OF ELECTRICITV COPV ❑a-nnnn�nne n� �nne