P - 77341REQUEST FOR ELECTRICAL INSPECTION
1�% Q���� O � Minnesota Board of Electricity � L� S-(�/�
� V 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYIMRS 1-800-627-3529 wxnv.e[ectricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL ENERGY SAVEC; ' S S4J I TCH
GENERALFEES
SERVICES / POWER SUPPLIES
0 to 400 Ampere $25
401 to 800 Am ere $50
Above 800 Am ere $75
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to }2 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
L' htin Retroft $.25 per Fixture
Center Pivot IrriQation Boom fa� $40
Traffic Signal Standard
Supplemental Fee @ $
Transformers u� to 10 I
L Transformer / 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 fee is $20)
I hereby certify that I inspected lhe elecirical inslallation descnbed herein on lhe dates stated:
Se arate Bondin Ins ection $20 G-G��- '°'� -o)
Special Inspection @$30 per Hour exaiaeo nbnNOOmeo onTE
Special Ins ection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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I IIN II I I I II �I II III II I II II I I I I I IN II �I II III I IIII
17813700
j"�' f �(¢�Q � Rough-in Inspection Required? ❑Yes �] No Inspection Other Than Rough-In: [�Ready Now ❑Will Call
�� ___ _ � 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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I�'°���r�fe�"�`l��IUBE fiL� _ _ ---- �cavl=�iTDLEY
Section
No. I County
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�i Oyrt{er(QFCUpar�t,t�arr�e,. �� - Please Provide Two (2) Phone Number
� ULbtM llfiV 1 i � � �
; Ele fi Utility � � � Elechical Utility Address
I� :�CG� � F�iC.IlG7�
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',CHU14i/ tLtl.ltt'lC ��FiF'��iAT1Uf'i 'contractor�gnse�y{rtapP,�� MasterElectricianor
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�1 Uti�iJ ' License Number
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; Mai6ng Address (Contractor, Company or Owner Performing Installation)
��3�4 TE�i�iITOFiIAL �pAD, SAIMT FAU! , M�I 55114
_ - - - - _ :.— _ _ _- � _ - -. . — -
Authorized Si nature (Contractor or Owner Performing Installation) —� � Please Provide Two�2 Phone Number
I � �65 i� 646—�'� 11 �
WSTRUCTIONS ON BACK OG VELLOW COPY BOARD OF ELECTRICITY COPY
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