P - 77345REQUEST FOR ELECTRICAL INSPE TION �
1����- 313 O Minnesota Board of Electricity o7(�%S ���3.� ;�, '
❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �: ;
(651) 642-0800 TTY/MRS 1-800-627-3529 ��x�tir.elec�ricitv.stale.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL ENE�iGY SAb'ER'S St�ITCH
GENERALFEES
/ POWER SUPPLIES
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aoaaratus (� $.50
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $25 per Fixture
Center Pivot Irriqation Boom an $40
Traffic Signal Standard
Supplemental Fee @ $
Transformers up to 10
Transformers over 10 V
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
Fee
TOTALFEE
total fee is $201 Z� S�%�
that I inspeded the electrical installation descnbed herein on the dates stated:
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Special Inspection $30 P2f HOUf exaiaec; nanr�oor�eo onTe I
Special Inspection $.31 per Mile
THIS 1NSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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I���i L�r(�c Rough-inlnspectionRequired? ❑Yes �NO InspectionOtherThanRough-In: [�ReadyNow❑WillCall
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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I Township
Range
�,, v�y}=eiyr}�:�;ru,.yv�m� I����� F I Nlease Provitle Two (2) Phone Numbers Including Area Code
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� Electrical Utility Electrical Utility Address
! XCEL ENERGY
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'.Cqr�(r�(�lGnmqar}y��eng� CO����F�A,i,l�i� � ,iContractorl.jFe�nse,[JU��� 'MasterElechicianorPowerLimitedTechnician
r��irv t���, ri.� LH t7V ,J LicenseNumber
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Maiting Address (Contractor, Company or Owner Performing Installation)
' �.i00 TE�iRITD�'IAL ROAD, SAIMT F'A�JL, Mhi 55114
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Authorized S' natura (Contractor or Owner Performing Installation) PI a e Pro i Two Ph ne Numbers Including Area Code
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WSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRIC:ITV �C�PV ca_nnnn�n_�c n� �nnn