P - 77350REQUEST FOR ELECTRICAL INSP E�C,TION -
1- 7 81- 318 9 Minnesota Board of Electricity �'QOS—(.��l� f �-
, ❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/M RS 1-800-627-3529 �rx iv. e[ectricitv. slute. mn. us
Describe -using the back of the white copy if necessa the work covered by this re uest:
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GENERAL FEES Outdoor Li hting Standard @$1
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
0 fo 400 Amcere an $25 Suoolemental Fee (� $20
Above 200 Am ere $10 �_
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Ao�aratus la� $,50
THE GENERALFEES
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liahtina Retrofit l�a $25 oer Fixture
Park Sites �
, ection $2C
$30 per Hour�
Transformers over 10 KVA $ 20
Transformer I Power Supply for Signs I Outline Lighting @$5
ONE 8 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
Fee
TOTAL FEE I �- �Q �
total fee is $201
that I inspected the electrical installation described herein on the dates stated:
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THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
IIII II III II I� � li{ II III N III II III II �I II III I IIII
17813189
��. ��f"+,+,��0 ry �. Rough-in Inspection Required? ❑ Yes �] No ''�, Inspection Other Than Rough-In: [�Ready Now ❑Will Call
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i �, You must call the inspector when ready! _�ate Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
I�o��cg�sc���ti�id�`�sR�OK �1�tY NE 'c�ivl=�iIDLEY '
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'�, Electncal Utility I Electrical Utility Address
' XCEL ENEf;GY '
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C r / C m I Contractor L� ense mber
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Mailing Address (Contractor, Company or Owner Performing Installation)
I�3fl0 TE�i�iITORIAL ROAD, SAINT F'AiJL, hlhi 55114
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�Authorezed Signature (Contractor or Owner Performing Installation) Please Prowd
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INSTRUCTIONS ON BACK OF VELLOW COPY BOARD OF ELECTRICITY COPV
�co��ty ANOKA
�wo (2) Phone Numbers Including Area Code
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Master Electrician or Power Limited Technician
License Number
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wo`(2) ih�ne Numbers Including Area Code I
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E&�0001A-15 8.1.2004