P - 77339REQUEST FOR ELECTRICAL INSPECTION
1� 7 8 1� 3 7 7 � Minnesota Board of Electricity �QO S'� �1�� �-r
1821 University Avenue Suite S-128, aint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 x�ww.electricity.stale.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL EhIEF:GY SAVEF;'S S41iTCH
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 Ampere $25 Supplemental Fee @$20
401 to 8�0 Am re $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I Power Su I for Si ns I Outline Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 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
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Insoection Tn�s (c� $20
ADDITIONS TO THE GENERAL FEES
TIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liahtinq Retrofit (�a $.25 oer Fixture
Park Lots �
Park Siles
$30 per Hour
ihat I
Fee
TOTAL FEE I 2�, 5a ze:ea
total fee is $201
the electncal installalion descnbed herein on the dates stated:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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17813775
���iL��a�j 'IRough-inlnspectionRequired? ❑Yes �]No '�InspectionOtherThanRough-In:[�ReadyNow❑WillCall
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� You must call the inspector when ready! j Date Ready:
I certify that I am the x0 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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' Oyu�{IQC&ypant A�qi���� � � Please Provide Two (2) Phone Numbers Including Area Code
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,• IeE ctrical Utility i Electrical Utility Address
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Cr / � � �, Con[rector nse �; Master Electrician or Power Limited Technician
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I Mading Address (Contracror, Company or Owner Performing Installation)
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Aufhorizad S' na�ntractor or Owner Performing Installation) i PI � Proyi�lSTwg,�� �hpne Numbers Including Area Code
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