P - 77364REQUEST FOR ELECTRICAL INSPECTION �
1����- 3 4 5 2 Minnesota Board of Electricity o�Q���j Sfpg �N�_ �'
❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �: ;
(651) 642-0800 TTY/MRS 1-800-627-3529 rox�x-.eleclricily.slute.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request
EXCEL ENEf�GY SAUER'S S�ITTCH
GENERAL FEES Outdoor LigMing 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
Above 800 Am re $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 & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $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, CIRWITS OF LESS THAN 50 VOLTS Additional Ins ection Tri s $20
Each Svstem Device or Apoaratus Ca? $.50 Investigative Fee
FEES
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Retrofit @ $.25 per Fixture
�ivot Irripation Boom (�a $4C
that I
Fee
TOTAL FEE aO •SO �8
total fee is $20)
the electrical installation descnbed herein on ihe dates stated:
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Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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17813452
j��ef�.�JQcy ���Rough-inlnspectionRequired? ❑Yes �No �I.InspectionOtherThanRough-In:[�ReadyNow❑WiIlCall
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�i_ I You must call the inspector when ready! . �Date Ready: _ .
I certiiy that I am the lY�l LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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%-please Provide Two (2) Phone Numbers I
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�I Electrical Utility I Electrical Utility Address
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iMailing Address (Contractor, Company or Owner Performing Installation)
' L�Q4 TEf;F�TTORI�!_ f;t7AD, SAINT F'AULq �1hI ��114
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Autho�ized Sgnature (Contraclor or Owner Periorming Installation) Please Provide Two (2 Phone Numbers �
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