P - 77400REQUEST FOR ELECTRICAL INSPECTION °
1-�8�-346 0 y o ��:� . ,
❑ Minnesota Board of Electricit �(�,�- /cg ib r
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 ��
(651) 642-0800 TTY/MRS 1-800-627-3529 �•1viro.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL EhlEF�GY SA�JE�i'S S4JITCH
GENERAL FEES Outdoor Liohtina Standard (� $1
0 to 400 Ampere @ $25
401 to 800 Ampere @ $50
Above 800 Ampere @ $75
CIRCUITS / FEEDERS
0 to 200 Ampere @ $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 per Fixture
Center Pivot Irrigation Boom @ $40
Manufactured Home Park Lots (� $25
Traffic Signal Standard @ 9
Supplemental Fee @ $20
Transformers uo to 10 KVA
� Transformer / Power Supply for Signs I Outline Lightin $5
ONE 8 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
Additional Inspection Trips @ $20
Investigative Fee
TOTAL FEE
(minimum total fee is $20) a�• S� �'��
the electrical installation described herein on the dates stated:
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Spec�al Inspection @$30 per Hour exaiReo aeaNOONeo
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN
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IIII II III II I� I I�I II III II I I I I I III N 111 I I IN I IIII
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l"�� j L4�� � 'i Rough-in Inspection Required? ❑Yes �] No 'I� Inspection Other Than Rough-In: [,kReady Now �Will Call
� � 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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Nlease Provide Two (2) Phone Numbers
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i c�ecmcai uuury '�� Electrical Utility Address �
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�t`i�i� �`���f`�'ic co�F°o�aT I --- - --
�1 � � � Contractor �gnse,[ly� �[ Master Electrician or F
i I a� ,� i.H U4'�t3J i License Number
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rMailing Address (Contractor, Company or Owner Performing Installation)
1 L300 TERfiITOC;IAL Rt7AD, SAIMT F'AUL, i�h! 55114
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�Authorized S' nature (Contractor or Owner Performing Installation) -�rPlease Provide Two�2 Phone Numbers
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INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY
Limited