P - 77384,� '�� REQUEST FOR ELECTRIC L INSPECTION �
1 �781 306 4 �-o � ��?��
� � ❑ Minnesota Board of Electricity / ;
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104 �:
(651) 642-0800 TfY/MRS 1-800-627-3529 www.electricilv.s7a�e.mn.us
Describe -using the back of the white copy if necessa the work covered by this re uest:
EXC�L ENEf;GY SA�1�R'S SWITCH
GENERALFEES
SERVICES I POWER SUPPLIES
0 to 400 Amcere (cil $25
� Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Each Additional Unit (� $25
Outdoor Lighting Standard @ $1
Traffic Siqnal Standard C�a $5
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer I Power Supply for Signs I Outline Li htin $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
Additional Inspection Trips @ $20
Investiaative Fee
Lighting Retrofit @$.25 per Fixture i
Center Pivot Irri ation Boom @$40 F
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 F
S arate Bondin Ins ection $20
Special Inspection @ $30 per Hour
Special Inspection @ $.31 per Mile
THI$ INSTALLATION MAY BE ORDERED DISCONNE�
illl II II� II I�� II �� II I� II III I I NI II il I I I�I I Ilil
178�,3064
TOTAL FEE L����
total fee is $201
� certify that I inspected the electrical installation described herein on the dates stated:
DATE
�ecrioN , oarE
�.:,,�� � L r_ ���
�ABANCONED DATE
D IF NOT COMPLETED WITHIN 72 MONTHS
I"'8'j1^.i L� fO 5 � Rough-in Inspection Required? LJ Yes �r] No i, Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
' You must call the inspector when ready! _ �ate Ready _ i
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I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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'��op��it�,��etAl�}�`iFIES A�1E �ciryFF:IDL�Y �
ITownship '�,, Section Range ��. Fire Na �ounty AhIQ KA I
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P Please Provide Two (2) Phone Numbers Including Area Code
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� Electrical Utility �Electrical Utility Address
I XCEL ENER�Y
� P� � i Contractor icense N mb r I Master Electrician or Power Limited Technician
��t`i�i�`'�€`C�`���'�e eo�F�o�arzor� `�a a�s�J LicenseNumber
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� Mailing Address (Contractor, Company or Owner Performing Installation) �
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�.���0 TE�iRITt7F�IAL hOAD SAINT F'AUL I*iN 5
Anthonzed S' nature Contractor or Owner Performin Installation � Please Provide Two (2 Phone Numbers Including Area Code
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INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY Ee-oonota-�5 s � �nna