P - 77355REQUEST FOR ELECTRICAL IN PECTIO �
1� 7 8 1� 3 2 O 5 Minnesota Board of Electricity �Q(���Q �/��� ��,� �'
❑ 1821 University Avenue Suite S-128, Sautit Paul, Minnesota`�5 04 - -
` (651) 642-0800 TTY/MRS 1-800-627-3529 witi•w.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL E�iERGY SAVEf;'S SWITCH
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 Ampere $25 Supplemental 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 I FEEDERS Transformer I Power Su I for Si ns I Outline Li htin $5
D to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CtRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Tri�s C� $20
TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL fEES
l.iqhtinq Retrofil a(� $.25 qer Fixture
Park Lots (
Park Sites
Hour
Fee
TOTAL FEE I ,�A � �
total fee is $201 �-"
that I insoected the electrical installation descnbed herein on Ne dates stated:
'-rs o6~
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
IIII � III I I III I I�I I I II I� I I! II I I I II I� II NI I I I II
I, 7 81 3 2 0 5
��i ��j1Ll}`(� �y I Rough-in Inspection Required? ❑Yes �]No I, Inspection OtherThan Rough-In: [�Ready Now �Will Call
I I You must call the inspector when ready! II Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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I,����ist`�.�fe�ilflY NE ��YFRIDLkY
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OW�.y{Op6HqanLNarJaa, I C� � Please Provide Two (2) Phone Numbers Including Area Code
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�, Electrical Utility II Electrical Utility Address
' 7CCEL EMEF�G`t �
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��°f' �`�`%`�`�`,iC L,t�RF'OhAi � ------
�I C T/ � _ I Q� Contractor I,ip�nse,N}{rpbP{.., Master Electrician or Power Limited Techni
t.H V�Jti�3 � License Number
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Mailing Address (Contractor, Company or Owner Performing Installation)
�st?t? TFRhITOf,IAL ROAD, SATNT F'A�JLq t�E�l 55114
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iAuHtorized S' ature (Contractor or Owner Performing Installation) - PI@y,�Proyicj��wg,�?„� ihpne Numbers Including Area Code
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