P - 77745' � REQUEST FOR ELECTRICAL INSPECTION
1��� J- 3 5 5 9� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.slate.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCE� EhiE�GY SAVEF.`S SWITGH
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffc Siqnal Standard (� $5
Above 800 Am ere $75 �
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit lc� $25
Irrigation Boom C
I Home Park Lots
Vehicle Park Site:
THIS INSTALLATION MAY BE ORDERED
II� I� III II I�� II I� II (II I) III �I III (I (II II III I III)
17?53559
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Transfortners u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer! Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Indudes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investigative Fee
Reinspection Fee $20
TOTAL FEE
(minimum total fee is $20)
THiSAREAFORINSPECTORUSEONLY L tl`
I hereby certify that I inspected ihe electrical installation described herein on the dates slated:
1-/fr'oS �
D IF NOT COMPLETED WITHIN_12
o`Z�OS- (�CSO ad �
� vaie: ! Rough-in Inspection Required? ❑ Yes Q No ��� Inspection Other Than Rough-In: � Ready Now ❑ Will Call
�'� i������5 You must call the inspector when ready! � Date Ready:
I certify that I am the [X7 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
- - --
�, Job Site Street Address �� � - � - �� � �a�
�VE ME
Section
; Owner/Occu ant Name
_ _-- --- -
P Please Provid�
� WHALEY Sr�T7 F � )
I Electrical Utility Electrical Utility Address
� XCEL EhIEF;CiY - --- I
IContrector / Company Name Contractor License Number
' HUhiT ELECTf,IC GOf:F'UhATI0�4 CA t?�}883
�_- _—_ -. . _. ___
' Mailing Address (Contractor, Company or Owner Performing Installation)
�304 TEhf�:ITOfiTAL FtOAD, SAIhET F'AUL, MN 5513.�
F�,IDLEY
iry
AMOKA
Phone Numbers Including
� )
Master tlectncian or
License Number
Authonzed Signature (Contractor or Owner Performmg Installation) ' Please Provide Two (2) Phone Numbers
� %� (�51) b46-�911 ( �
INSTRUC710NS ON BACK OF YELLOW COPY BoARn oF Fi FcTRiciTV cncv