P - 77337''7p REQUEST FOR ELECTRICAL INSPECTI N �
1� 1 O�- 3 7 5 9 Minnesota Board of Electricity �/y��- Q����j '��,� '
❑ 1821 University Avenue Suite S-128, i 75au1, innesota 5104 �. .
(651)642-0800TTY/MRS1-800-627-3529 �ixror.electricih�.stule.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request;
EXCEL FMER�Y SAt1EF; `S SWITCH
GENERAL fEES Outdoor Liahtino Standard an $1
0 to 400 Ar
A01 to 800
Above 800
;UI7S I FEE
� CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERAL FEES
fIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units a(� $50 Per Unit
Genter Pivot Irrigation Boom @ $4(
AAanufactured Home Park Lots @ g
Recreational Vehicle Park Sites @
Separete Bonding Inspection @ $2
Special Inspection na $30 per Hour
Traffc Signal Standard @ $5
Supplemental Fee @ $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $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 Ins ection Tri s $20
Investigative Fee
Reinspection Fee $20
TOTAL FEE .a��
(minimum total fee is $20) �•S� `
iH15 AREA FOR INSPECTOR USE ONLV
I hereby certify that I inspected the elecMcal installation descnbed herein on the dates stated:
ROUGHIN DATE
F!NAL INSPECTION DATE
���—c�'/ - /�'i— O,�
THlS IWSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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17813759
I ��e�L��� c ��,� Rough-in Inspection Required? ❑Yes �No I Inspection OtherThan Rough-In: [,�Ready Now ❑Will Call
� ` I You must cali the inspector when ready! I Date Ready:
I certify that I am the I� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
������t�e�ilA�s��VAFiIAN F'AS �c�tvFRID�EY
'i TawnShip �� Section � Range 'I Fire No. �, County �j W j"j j,f A
�� ��i�l*��`���s°'� E�RUCE _ I - -- —I�— - — _ �
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' Electncal Uhlity i Electrical Uhhty Address � �
� XCE�. ENERGY
HUhiT ELPE�TRiC CORh'ORAT�__ _
� Contractor! Com an Name � � Contractor License Number
- zar� ca Qaae.� �
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Mailing Address (Contractor, Company or Owner Performing Installation)
'���J4 TEf:f;ITORIAL RCIAD, SAIhlT F'AUL, t��! 55114
--- -- --- _ - __ _ _ � _
Authorized Signature (Contractor or Owner Performing Installation) I Please Prov�de Tw
I `�%wW s�it�iN� -- -- '(65� 646-
ULSTRl1CT10NS ON BACK OF VELLOW COPV RnARfI f1F FI F�TRI(`ITV !`nPV
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Master Electrician or Power
License Number
li � �
Area