P - 79746� REQUEST FOR ELECTRICAL INSPECTION p.sE..,
Minnesota Board of Electricity
1-396-561 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 _
(651) 642-0800 TTY/M RS 1-800-627-3529
www. electricity. sta te. mn. us
Identity the work covered by this request
X XGEL ENEROY SAVER'S SWITCH
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES I POWER SUPPLIES Trattic Si nal Standard �$5
0 to 400 Am re �$25 Su lemental 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 Transformers / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Suppry up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS. CIRCUfTS OF LESS THAN 50 VOLTS Additional Insoection Trips �$20
Each
Y DWELLINGS
FOfl INSPECTOR IISE ONLY
n
TOTAL FEE
total fee is $20)
Pivot Irri ation Baom � $40
otured Home Park tots �$25 I hereby certily that 1 inspected Me electrical installetlon Uescribed herein an ihe dates steted:
ional VehlCle Park SReS �$5 ROUGH IN DATE
e Bondin Ins ection � $20 �1
Ins 'on �$30 8f HOUf FIWILINSPECTION DATE
Ins ection �$.31 er Mile ` �� Z f��
INSIALLATIQI�L AAAYAE QRDERED �1�CQN1PI�CTEDJE T�4MPLEIFJZI�►1T1�tN11��4t1IH$__ � _
FOR OPFICE USE ONLY
IlIIIIII�IINIIIN�NINII�I�IIlII�I�IIl� � ���
* 1 396561 1 * '� c�27,,s-d
Reque Rough-in Inspection Requiretl? ❑ Yes No Inspection Other Than Rough-in: peady Now ❑ Will Call
Yau must call the inspedor when ready! Date Ready:
I certi(y that I am the C] LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Addres��, so����V cnv �p�Y ziv �a 55d32
Section Township Range Fire No. County
occu�0� ANCIREA 8 �� Phone
0 r d:l
Power 561�21ie[ � Address
RGtI.
E����E���'�RATI4N Contractor Lic�p�e� Master license Number
V/i
Mailing AddrecslCoaVSOtar,,1'aotoiinvoc�dnwe; Ba��ipyptioul.. 5�3� � 4
LJW ItfiK11CM1ALl�l�W b VI..� MPI
Aulhoriz ' nature (�tract � om a or Owner Perfortning Installation) Phone �1 ���,
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY