P - 77332REQUEST FOR ELECTRICAL INSPECTION
1� 1 V�- 3 2 3 9� Minnesota Board of Electricity ����_ D���
1821 University Avenue Suite S-128, Sai u, Minneso a 51 4
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL EhEEfiGY SAt�Efi'S StJITCH
GENERAL FEES Outdoor Li hting Stand
I POWER SUPPLIES Traffic Signal Standard
0 Ampere @$25 Su�olemental Fee a(� $
Above 800 Am ere $75
CIRCUITS / FEEDERS
D to 2�0 Am ere $5
Above 200 Am re $10
AIARM, 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
� Transformer I Power Supply for Signs I Outline Lighting @$5
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
Additional Inspection Trips @ $20
Investiqative Fee
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TOTAL FEE �
(minimum total fee is $20) Z� •� '`
I hereby certiry that I inspected the electricai installation described herein on the dates stated:
Manufactured Home Park Lots $25
ftecreational Vehide Park Sites $5 Fir�a� iusFECrioN oarE
Se arate Bondin Ins ection $20 �—'�---�--�- ��Yp : e'
Special Inspection @$30 per Hour exPiaeo aenNOCSeo on.e
S cial Inspection $.31 per Mile
THIS INSTAlLAT10N MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
IlII Ilill il I� il lil II III II III II III II III II III I IIII
17813239
'�, "'�/y 1��4 � I Rough-in Inspection Required? L� Yes �] No �� Inspection Other Than Rough-In: [�Ready Now ❑Will Call
` __ I 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''��}fei�`t�Y nfi hIE .__ �cityFRlllLEY
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Please Provide Two
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�. EleGrical Utility '�, Electrical Utility Address
I XCFL ENE(�GY I
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�� ��� I Yt lC GQRF'OFtATI Ohl contractor �ic�nse���� ' Master Electrician or Power
j License Number
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� Mailing Address (Contrac[or, Company or Owner Performing Installation)
�30U TEF�hITORIAL ROAD, SAINT F'AUL, MFI 55114
4 Authorized Si nature (Contrac[or or Owner Performing Installation) i���ProyicJ� Jwq.�?„1 �hyne � mbers Incluc
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IMSTRUCTIONS ON BACK OP YELLOW COPY �� BOARD OF ELECTRICITY COPY ❑a_r
Area Code
Area Code