P - 77395REQUEST FOR ELECTRI L INSPECT ON k
1����- 3 6 0 1❑ Minnesota Board of Electricity o�C�d�� C�l��j� ;�-- -
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � �
(651) 642-OS00 TTY/MRS 1-800-627-3529 ivwiv.electricilv.state.mn.us
Describe -using the back of the white copy if necessa the work covered by this re uest
EX��L ENERGY SAV�R `S StJiTrH
GENERAL FEES Outdoor Liphtinq Standard (a� $1
SERVICES / POWER SUPPLIES
0 to 400 Ampere @ $25
401 to 800 Am re $50
Above 800 Am ere $75
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lightin Retroft @ $.25 per Fixture
Center Pivot Irri ation Boom @$40
DAanufactured Home Park Lo�s an $25
Traffic
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer / Power Supply for Siqns / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiqative Fee
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TOTALFEE
(minimum total fee is $20) ��SQ ��
that I inspected the elecMcat installation described herein on the dates stated:
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5pecial Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS _
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i"��L(,��� 5 �I Rough-in Inspection Required? ❑ Yes �] No I Inspection Other Than Rough-In: [�Ready 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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', °���'�i �fi`� �aT hIE Ic�ry�FiID�EY
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i i ownsmp '. Section �
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I��}����'P�an� �i��°i'� A N A
', Fire No. 'I C
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I Please Provide Two
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I tiecmc2i Vtmty I Electrical Utility Address
'� XCEL EhiERGY
IC�it���� ELEnI.TRIG G�Ft�' � !Contractor�icense umber
QRATIOhI CA ��J88.� �
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MaAing Address (Contractor, Company or Owner Performing Installatwn)
I�300 TE�i�iITOKIAL fiOAD, SAINT F'AUL, hiN 55114
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� Author2ed Signature (Contractor or Owner Performing Installation) � 7Please Provide Tw
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INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPV
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Jumbers Including
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Master Electrician or Power Limited Technician
License Number
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L� ih�one Numbers Including Area Code
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