P - 77393REQUEST FOR ELECTRIC L IN ECTION �`��,
1� f�0 1= 3 5 5 1❑ Minnesota Board of Electricity � a `� _`_ �'.
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1821 University Avenue Suite S-128, Saint Paul, Min�ot��04
(651) 642-0800 TTY/MRS 1-800-627-3529 N�wx�.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCGL ENEFiGY SAV�fi'S SWITCN
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Sianal Standard C�a $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
UITS I FEEDERS Transformer I 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
2M. COMMUNICATION. REMOTE CONTROL. SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
I CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE
MILY DWELLINGS (PER Uf
12 Units @ $50 Per Unit
FEES
i Home Park Lots @ g
Vehicle Park Sites @
iding Inspection @ $2
iction an $30 per Hour
TOTAL FEE
nimum total fee is $20) o��-S(� �
I insDected the electrical installalion described herein on the dates stated:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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17813551.�
� u�e jG4 f� � j Rough-in Inspection Required? ❑Yes � No I Inspection Other Than Rough-In: [s�Ready Now QWill Call
� You must call the inspector when ready! �'�. 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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Township
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r°�`��"f'�i1e CHR�;LES W
, Kange
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�� Elec[ncal Uttlity ! Electncal Utility Address
; XCEL Eh!Ef�GY
K�t�9� �����'�ic co���o�aT _ -----
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'� C n r c / � ��� � '' Contractor I,icgnse,.(Vxrypp�R
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�.. Mailing Address (Contractor, Company or Owner Performing Installation) II
�' L304 TERRITi7f;IAL �;OAD, SAIhIT F'AUL, M�I 55114
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�horized Si9natur�ntractor or Owner Performing Installation) P sal e Proyid
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INSTRUCTIONS ON 6ACK OF VE�LOW COPV A(�ARII nF FI F(:TRI('ITV f'f]PV
Master Electrician or Power Limited Technician I
License Number
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