P - 77375REQUEST FOR ELECTRICAL INSPECTION
1� 7 81= 3 5 7 7� Minnesota Board of Electricity �("��� -� /�Q�
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 x�K��v.elech•icitv.state.mn.us
Desaibe -using the back of the white copy if necessary - the work covered by this request:
EXCEL ENERGY SAUER'S S�IITCH
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 Ampere no $25 Suoolemenlal Fee na $20
Above 800
;UITS I FEE
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Center Pivot Irrigation Boom @
Manufactured Home Park Lots (
Recreational Vehicle Park Sites
Hour
Transformers over 10 KVA $ 20
Transformer I Power Supply for Signs / 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
Investiqative Fee
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TOTAL PEE �� �,,��-f�ty
(minimum total fee is $20) ?� • �> lS"'" °'" "
that I inspected the electrical installation descnbed herein on the dates stated:
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THIS INS7ALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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L78�,3577
i u�e�� j}�a c �i Rough-in Inspection Required? ❑Yes �] No �' 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 ceRify that I am the 0 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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�I Electrical Utility � Electrical Utility Address
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:
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� MaAuig Address (Contrector, Company or Owner Performing Installation)
' 2,a�t4 TEhRITORIAL FiQAD, SAIldT F'AUL, �Ih! 5:114
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Authorized Signature (Contractor or Owner Performing Installation) '` Please Provide Two (2 Phone Numbers
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INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY
�I section �� Range
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a�o�sa
Numbers Including Area
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