P - 77399� REQUEST FOR ELECTRICAL INSPECTION �
�'�• �'g 1� 3 � 5 � Minnesota Board of Electricity ��..b��� `��
1821 University Avenue Suite S-128, aint Paul, Minnesot�5104 �
(651) 642-0800 TTY/MRS 1-800-627-3529 wx�w.electricity.state.mn.us
Describe •using the back of the white copy if necessary - the work covered by this request:
EXCEL EhlERGY SA�1EFi ' 5 8W T TCH
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPLIES Traffic 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 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service and/or 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
Each System Device or A�oaratus n� sn Additional Inspection Trips $20
Units @ $50 Per Unit
iditional Unit @ $25
SI�QS
(minimum total fee is $20) I �•�l��Q
THIS AREA FOR INSPECTOR USE ONLY
that I inspected the electrical installation described herein on the dates stated:
DATE
/> qOATE �
. , 2C�-�i
opeaa� inspection m g.31 per Mile °""
TH(3 INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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17813056
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Rough-in Inspection Required? ❑ Yes �] No I Inspection Other Than Rou h-In: f7�Read Now
9 JC Y ❑ Will Call
You must call the inspector when ready! �� Date Read
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I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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I�30�J TERRTT�RIAL Rt7AD, SAThfT F'AUL, lrlhl 55114 -----
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i Authorized Siggg nature (Conhactor or Owner Performing Installation � -
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7� ;� � PI Pro i w Ph ne Numbers Includin Area
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I INSTRUCTIpNS ON BACK OF YELLOW COPV �� � �---- -- --
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