P - 773511 7 81 317 a REQUEST FOR ELECTRIC L INSPEC 10
� � Minnesota Board of Electricity (��j�- �( ,3
1821 University Avenue Suite S-128, aint Paul, Minnesota 55104
� (651)642-0800TTY/MRS 1-800-627-3529 x�ww.eleclricity.stale.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL E(�ERGY SAVEfi'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 re $50 Transformers u to 10 KVA $10
Abpve 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
0 to 200 Am re $5 ONE 8, TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $90 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
C�RCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20
Each Svstem Device or Aooaratus na $.50 Invesliaative Fee
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liahtinq Retroft a(� $.25 per Fixture
I Home Park Lots �
Vehicle Park Sites
Hour
�n
*�h .: -
:�y< �j� ` _
TOTALFEE 2o,�O �
total fee is $20)
that I inspected the elecMcal instailation described herein on the dates stated:
. �. �_ Cr� I
THIS IN$TALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
IIIIIIII�III�IIHIIII�IIIIIIIIIIII�III�IIIII
1781317],
��!^l.� f'1� �j I Rough-in Inspection Required? ❑ Yes �] No I Inspection Other Than kough-In: [�Ready Now ❑Will Call
I You must call the inspector when ready! I Date Ready:
I certify that I am the � LICENSED CONTRACTOR p COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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'�°l��b�fe�' .�ii+�lOD WA`t hIE IcavFF:IDLEY
'rOi�f'd'�'�i�"` �� � Y D
, ElectC rical Utility
i xr�� EMEf;GY
Utility Address
�'I ����� ����C CuRF'ORAiIOM � �ontractor ��nse�v�� J iutaster tiectncian or Nower �imrted i
i License Number
C— — — — �— — � — — -_ __ _. __ —. .. — -- — — -- -- — — ---� - -------- —
Maifng Address (Contractor, Company or Owner Performing Installation)
I t3�30 TEf,R.T.7t7RIAL FiOAD, SA7NT F'AUL. �IN 551i4
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Autltorizsd S" naWre Contractor or Owner Performin Installation TPI Pro i w Ph ne Numbers Includin Area
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