P - 773521 1 REQUEST FOR ELECTRICAL INSPEC I N �
1��� 1— 319 7 Minnesota Board of Electricity p7oO�' d �� ;�- `'�1
r ❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 _ -
(651) 642-0800 TTY/MRS 1-800-6273529 x�x�w.eleclricity.stnte.mn.us
Describe -using the back of the white copy if necessary - the work covered by ihis request:
EXCEL ENEFiGY SAVEfi ' S S4) I i CN
GENERAL FEES Outdoor Liahtina Standard (� $1
�ICES I POWER SUPPLIES
0 to 400 Amcere (� $25
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apoaratus no $.50
ADDITIONS TO THE GENERAL FEES
iIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liphtinp Retrofit (� $.25 per Fixture
Lots 1
Sites
Hour
Supplemental Fee @ :
Transformers up to 10
Transformers over 10
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
Fee
Fee
imum total fee is $20) ��•�� `-�"�'�'
I hereby certify that I inspected ihe electrical installation described herein on the dates stated'.
_ z F-�,�
�NIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
IIII II 81 il �i II III II III �III II III Ii lll II I� I II�
L7813197
� v���4�(� �j � Rough-in Inspection Required? ❑Yes �i] No � Inspection Other Than Rough-In: [�Ready Now ❑Will Call
i
'�� j You must call the inspector when ready! I 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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J°��.��s`��`'h''`��`�WAY h!E I� Ff,IDLEY
�i Township I Section � Range Fire No. I� County a�nKa
', u11r1rUl"-tLLt m�CHAD I ���1�"i I Please Provide Two (2) Phone Numbers Including Area Code �
!\ � \ /
I Electrical Utility �Electrical Utility Address
xrE� Eh1EF:GY
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�Cpq(r�(�/Coqiqa�Al�� ���F���IAT,I��i � �ontractorL,iC�nse,�V}{rq�iQ{�asterElectricianorPowerLimitedTechnician
, i-IUM tLt Ihl �� �l��rs�s LicenseNumber
ailing Address (Contractor, Company or Owner Performing Installation) �
��aOQ TERFiITOF�I:r�L. ROAD, SA7:NT F'AUL, MN 55114
' _ _—_ ---- _ - - --- �_ - - - - -- —.
Authori�d S' ture (Contractor or Owner Performing Installation) � PI� y Proyic��wo,,s?„1 ih�Qne Numbers Including Area Code
�w �� � �b�� b�� ``' ` ( )
INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPY EB-00001A-15 8.7. 2004