P - 77398REQUEST FOR ELECTRIC .L INSPE TION �
1����- 3 71 8❑ Minnesota Board of Electricity �(�s � ���
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
Descnbe -using the back of the white copy if necessary - the work covered by this request:
EXCEL EhfE�;GY SAVER `S S�lI7CH
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Tra�c Signal Standard @$5
0 to 400 Ampere $25 Supplemental Fee @$20
401 to 800 Am ere $50 Transformers u to 10 KVA $10
Above 800 Ampere @$75 Transformers over 10 KVA an $ 20
��,4RM, COMMUNICATION, REMOTE CONTROL,
;IRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
7ULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit �a $.25 per Fixture
Center Pivot Imqation Boom (a� $40
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
Fee
Fee
total fee is $20) �a.sd�"
ihat I inspected the eleclrical inslallation descnbed herein on the dates stated:
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Se arate Bondin Ins ection $20 � 2°�- �`,�
S ial Inspection @$30 per Hour exaiReo �enNOONeo onre
Special Inspection @ $.31 er Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
I IIII II III II III II I� II I� II III II NI II I� II IN I IIII
17813718
� ! Rou h-in Ins ection Re uired? ❑Yes No
, %c�'..�i �� 9 P 9 � InspectionOtherThanRough-In: [�ReadyNOw❑WiIlCall
IYou must call the inspector when ready! ; Date Ready:
I I certify that I am the 0 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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{'Iui9 tt.. I l�Fl V Jtit'3,J License Number �
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Mailing Address (Contractor, Company or Owner Performing Installation)
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;� Autiwl rizad Si nature Contractor or Owner Performin Installation i PI a„s Proyic�� Tw 7j Ph,pne Numbers Includin Area Code
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M6iTRUCTIONS ON BACK OF YELLOW COPY aoaRn f�F Fi FcrRiarv cnPV �e ,,..,,�.. ,� a..,,.,..