P - 77335/� REQUEST FOR ELECTRI AL INSPECTION
�!�� 1- 3 7 3 �} Minnesota Board of Electricity ����- 61�%� �:±�
❑ 1821 University Avenue Suite S-128, int Paul, Minnesota ��104 �. ,
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL EME�:GY SAVE�:'S S4JITCH
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Tra�c Signal Standard @$5
0 to 400 Ampere an $25 Suoolemental Fee (� $20
AtARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
� Each System Device or ApDaratus a(2 $.50
Additional Unit @
Lighting Retrofit @ $.25 per Fixture
Center Pivot IrriQation Boom (�a $4C
Transformers over 10 KVA $ 20
Transformer I Power Supply for Signs I Outline Lighting @$5
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
Investiaative Fee
TOTAL FEE la� ��,.,,, ,,,t
(minimum total fee is $20) �s`'-�r�`�
the electncal installation described herein on the dates stated:
Special Ins ction $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
I
IIIIN8III���lIII�IIIIfII�IIIIIIIHIIIIII
17813734
I��1�s41��j !Rough-inlnspectionRequired? ❑Yes �]No IlnspectionOtherThanRough-In:[�ReadyNow❑WiIlCall
_ __ ._ I You must call the inspector when ready! I Date Ready:
—
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER
-- — -- ----
--.--
,'�0��`��`�`�`�IB� f:U 4J
'�, �ownship I Section i Range
i------ ._ _.— _ _ _.— ..�__ _ .. �_.. — -
�°�`�'�Y�"'�'gZARETH SHEfiIDAM
and hereby request inspection of the electrical work at:
- -T�iY —
� F�;IDLEY
Fire No. I County
Please Provide Two (2) Phone Numbers I
\ / \ �
', Electrical Utility ���� Electrical Utility Address
'� ��EL ����1C71 �
r- -- - - - .. .---`.. . ----- - -- —
� CqQ(r��qc /G� r�par}yy �{n� ��- � 1 ContractorL,�' nse,(J }�rppp[ Master Electrician or Power Limited Technician
� P'It+��l tLtl..I111C C�Fti�'��{�T�Q� l�� Ulltii3J �LicenseNumber
� —_ —. _-- --- - ------- - - �-
' Mailing Address (Contractor, Company or Owner Performing Installation)
j��00 TEh�:ITQFIAL F:OAD, SATNT �'AUL, MN 55114
r--- -- - - - - --- — —
Authorized Si nature (Contractor or Owner Performing Installation) PI e Pro i e Two� Ph ne Numbers Including Area Code
�� �� --- --- II ��� ��6—t�l � � �
INSTRlICT10N5 []N 61CK nF VFI I f]W C.[1PV R(1GR(1 f1F FI Ff'TRI(`ITV (`(1PV co.nnnn�n �c o� �nnn