P - 77388REQUEST FOR ELECTRICAL INSPECTION �'�
1�� ��- 3 6 7 6 Minnesota Board of Electricity � q�S- p/�g7 `� �e �:
❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 I
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(651) 642-0800 TTY/MRS 1-800-627-3529 N�+�i+�.electrlcity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
E?CCEL EMEf�GY �AVEF�'S SWITCH
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I 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 Ampere (� $75 Transformers over 10 KVA fa� $ 20
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus C� $.50
ADDITIONS TO THE GENERAL FEES
iIFAMILY DWELLINGS (PER UNIT)
3 to t2 Units @$50 Per Unit
Each AddiGonal Unit @ $25
OTHER ADDITIONAL FEES
Liqhtinq Retrofit na $.25 per Fixture
Hour
ONE & 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
Fee
Fee
�vir��r�� �CV � "�
total fee is $20)
I hereby certify that I inspected the electrical installation descnbed herein on the dates stated:
,2
THIS tNSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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178L3676
���L (� f��j I Rough-in Inspection Required? ❑ Yes � No �'�, Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
� _ �i You must call the inspector when ready! j Date Ready:
I ceAify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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I �°� �t� �t�ee�,�tr� A VE hl E ���t f= I"i I D L E Y
'�. Township � i Section ! Range , Fire No. �, County (.��(� �A
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Please Provide Two (2) Phone Numbers I
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'� Electrical Utility ', Electrical Utility Address
XCEL EhIERGY _ �I
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-�44I�8GEQ[�COt7�qar}1(��P.� � ���F,���..i.I�� ,ContractorLiGense,[Jy{rt�p�.., MasterElectricianorPowerLimitedTechnician
1'fllhli tL.CI, hl l,fa UVt3 � LicenseNumber
: MaiNng Address (Contrector, Company or Owner Performing Installation) �� -
!.�3q0 TERRITOF:IAL ROAU, S�tINT F'AllL, Mh! 55114
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Authorized ' nature (Contractor or Owner Performing Installation) - PI Pro i wo Ph ne-Numbers Including Area Code
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INSTRUCTIONS ON BACK OF VELLOW COPY BOARD OF ELECTRICITV COPV Fa_nnmm�_�s a� �nne