P - 77396REQUEST FOR ELECTRIC L IN$PEC �
1� 7 8'1 � 3 O 7 2 Minnesota Board of Electricity p�(�� S� U�� /� ;r ,e�?
� ❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627-3529 x�xir.eleclricity_state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCE� Eh�EF:�Y SAVER `S SWTTCH
GENERAL FEES Outdoor Lighting Standard $1
SERVICES / POWER SUPPLIES Traffic Sianal Standard (o� $5
0 to 400 Ar
401 to 800
Above 800
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
� Retrofit @ $.25 per Fixture
Pivot Irrigation Boom @ $4C
ctured Home Park Lots @ $
tional Vehicle Park Sites fa� ;
Supplemental Fee @ :
Transformers up to 10
Transformers over 10
ONE & TWO FAMILY DWELLINGS, EACN 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) I 2�•����
that I inspected the electrical installation descnbed herein on the dates stated:
r- �`S
Special Inspection @ $.31 per Mile
TFFIS INSTAILATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
I IIII II I� IIII� III� (I III II�II II III II I� II I!I I IIII
1 7 8 1 3 0 7 C
�� "���i�r� �j � Rough-in Inspection Required? ❑Yes �) No �''�, Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
'��� _ _ I You must call the inspector when ready! ��i Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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J�p�.�c�4�` `a�ir� ST cavF�iIDLEY
ITo nw ship Section � Range Fire No. County (.� ��('� �(�
!°.�f`�i�`��Ue �OBEi;T H
Please Provfde Two (2) Phone Numbers
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j XCEL ENERr,Y '
�(.i�i°� ��.`��f`�"�c ra�F�a�aT -- - -
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C r / ContractorI.�' gnse,[J�{r�¢�{T Master Electrician or Power Limited Technician
� ���i —j L.fi Vtl�St'iJ LicenseNumber
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� Mailing Address (Contractor, Company or Owner Performing Installation)
'��00 TE�,f:ITtIF�IAL ROAD, SAIhlT F'AUL, Mhl 551i4
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rAuthorized Si natura (Contractor or Owner Performing Installation) � j PI �, Proyi��wq�?� ihpne Numbers Including Area Code
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WSTRUCTIONS ON BACK OF VELLOW COPY BOARD OF Fi FciRici7v cnav �o ����, �,� o,,..,..