P - 77370REQUEST FOR ELECTRICAL INSPECTION �
1. �81 369 2 �, �
� � ❑ Minnesota Board of Electricity ;r -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529 xww.eleclricitv.stale.mn.u.r
Describe -using the back of the white copy if necessary - the work covered by this reques�: �� ��� � �
EXCEL ENEF�GY SAt�ER'S S4IITCH
GENERALFEES
SERVICES I POWER SUPPLIES
0 to 400 Ampere @ $25
401 to 800 Ampere @ $50
Above 800 Ampere @ $75
CIRCUITS I FEEDERS
0 to 200 Ampere @ $5
� Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Uni�
Traffic Signal Standard
Supplemental Fee @ $
Transformers up to 10 I
Transformers over 10 M
� Transformer / Power Supply for Signs / Outline Lighting @$5
ONE & TWO FAMILY DWELLWGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
ivih�r�� �
total fee is $20) -S�
Lightin Retroft @$.25 per Fixture I hereby certify that I inspected the elecMcal installation described herein on the dates slated:
Center Pivot Irri ation Boom @$40 Rouc� ��, oa,e
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 F�Nn� �NSPec,�oN onre
Se arate Bondin Ins ection $20 � 2� o�}�
Special Inspection $30 pe� Hou� =_xPiReo nenNOOn onre
Special Inspection @ $.31 per Mile
THIS IWSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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I u�{e;,,5� f� 5 '� Rough-in Inspection Required? ❑Yes �] No I Inspection Other Than Rough-In: [�Ready Now ❑Will Call
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'i � You must call the inspector when ready! � Date Ready:
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I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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iJob iteStr fAddress-- -----_. --------.._- ------� ----------------ICily
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No. � County ���
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j Please Provide Two (2) Phone Numbers
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� Electrical Utility �,,' Elechical Utility Address �- i
xt��� �r�E�cY �
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�ICqn�r�cj�rlC�g��r�y,�,�m�� Ga�1�����'.A,i,�.ai�i �Contractor�nse��{rr�p�„, MasterElectricianorPowerLimitedTechnician I
��i�.�r� i�. �� [1ti .3 I License Number I
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�Mailing Address (Contractor, Company or Owner Performing Installation)
�; �:�00 TEI;RITilRIAL Rt�AL�, SAIhIT F'AUL, htN 55114
�---.i Authorrzed Si nature Contrac[or or Owner Performin—Installation �-;i Please Provide Two (2 Phone Numbers Including Area Code
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INSTRUCTIONS ON BACK OF VELLOW COPY BOARD OF ELECTRICITY COPY FR-f10001G.�5 n � �nna