P - 77378REQUEST FOR ELECTRIC L INSPECaTION
1�� O�= 3 5 3 6 Minnesota Board of Electricity G�� �^ ��U %� ''�e�� '
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1821 University Avenue Suite S-128, Saint Paul, Minnesota 5104 �. ,
(651) 642-0800 TTY/MRS 1-800-627-3529 wtivw.electriciry.stule.mn.us
Desaibe -using the back of the white copy if necessary - the work covered by this request:
EXCEL EN�'RGY SAUFF� "S SWITCH
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / 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 I FEEDERS Transformer / 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 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 Additional Ins ection Tri s $20
Each Svstem Device or Aooaratus la� $.50 Irnestioative Fee
3 to 12 Units @$50 Per Unit
Each Additional Unit Q $25
OTHER ADDITIONAL FEES
Liahtina Retrofit na $.25 oer Fixture
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total fee is $20) �' ��'"4'r,°�
that I insoected ihe elecirical installation described herein on ihe dates stated:
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S cial Inspection $30 per Hour `""'"`° """"°""`° °""
Special Inspection @ $.31 per Mile
TNIS 1NSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
IIII � III II I� II I� II I� II III II �I H III II III I!I�I
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�'�, U�lL(}�� �j I� Rough-in Inspection Required? ❑Yes �] No �'I Inspection Other Than Rough-In: [,�Ready Now ❑Will Call
i �I You must call the inspector when ready! I Date Ready:
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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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�r�'��r���t���`��F`iLITE BLVI} icav��ID�EY
��, Township
;°'�'��E°�`��'g�aus sau�o
Section I Range I, Fire No. � County �{� p KA
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� ��Please Provide Two (2) Phone Numbers Including Area
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I Electrical Utility ', Electrical Utility Address
XGEL EhlERGY
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��pqkyFt�/G�rnqar}y-0IameG �p��,���.�i�� Contractorl,icanse,(Jyirpbp{� MasterElectricianorPowerLimitedTechni
I t'IUIY cLGI, i hJ. l�t-1 t�lttf[3 �LicenseNumber
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I Mailing Address (Contractor, Company or Owner Performing Installation)
� �'�d0 TE�,F;ITORIAL fi0a�i, S�4IhIT F'AUL, �Ihl 55119
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AuthorizQd Si � na�ntractor or Owner Performing Installation) II PIEa,S�Proyicl� jwq,�7„1 ihpne � mbers Including Area Code
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