P - 77377- REQUEST FOR ELECTRICAL INSPECTION �
1� 7�81- 3 6 8 4� Minnesota Board of Electricity �OQ �-d lcgy� r- _
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 x�ww.e[eclricity.stute.mn.us
Descnbe -using the back of the white copy if necessary - �he work covered by this request:
EKCEL EMEf;GY SAVE�:'S SWITCH
GENERALFEES
SERVICES I POWER SUPPLIES
0 to 400 Ampere $25
401 to 800 Am ere $50
Above 800 Am ere $75
CIRCUITS / FEEDERS
0 to 200 Ampere @ $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERAL FEES
fIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot IrrioaHon Boom (� $40
Traffic Signal Standard
Supplemental Fee (a� $
over
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
��„
that I
Fee
Fee @ $20
TOTAI
iimum total fee is
aa�s��
the electrical installation descnbed herein on the dates stated:
��� � ���
S 2CI81 If1Sp2Ction @$30 pef HOUf exvweo nenNOOiu�e--� onTe
S ial Inspection $.31 per Mile
THI$ INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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1 7 8 L 3 6 8 4
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Rough-in Inspection Required? ❑Yes �] No I Inspection Other Than Rough-In: [�Ready Now ❑Will Call
You must call the inspecror 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�Township i Section �� Range Fire No. � County �j�(� ((�
I �I4 �rC.�ULb"��STAS L---- � �� � --- �— �I Please Provide T�� -- --
I, � � wo (2) Phone Numbers
i li � � � �
l, ElecVical. Utility E ectl rical Utility Address
I �i�f°� ���`i`�"�c c������a� �,
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�C r / z�� � ConUactor ljGe,�nse,[VUrpbg{� �aster Electrician or P
l H V V�its License Number
-- — —_.. —..— _ _ ._. ... — — _. .-- — -- -� _- __ — I — ----
j Mailing Address (Contractor, Company or Owner Performing Installation)
!�,:sd0 TEi;hITt��iIAL ROAD, SAIhIT F'AUL, �iN 551:i4
i__ _ __ -- - - - - -- -- - - =-- - -
I Authorized Si nature (Contractor or Owner PeRorming Installation) �- - � PI e Provi e Two Ph ne Numbers I
� 7� s� I(��], 6�b-��i �� �
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INSTRUCTIONS ON BACK OF VELLOW COPY annRn nF Fi FcTainrv cnPv
Technician I