P - 77343REQUEST FOR ELECTRI AL INSPEdC�TION �
�� ���- 316 3 Minnesota Board of Electricity o�(�(�S" 0�c�J� ;� �'
❑ 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS 1-800-627-3529 u�ww.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL EhlEFiGY SAVEFt'S S4JITCN
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES I POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 Amcere a(� $25
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit @
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irripation Boom na $4C
Supplemental Fee @ $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transtormer I Power Su I for Si ns I Outline Li htin $5
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
Additional Inspection Trips @ $20
Investigative Fee
Reinsoection Fee na $20
TOTALFEE
total fee is $20) 2�'�� ��
that I inspeded the electrical installation described herein on the dates stated:
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Special Inspection @ $.31 per Mile
THIS 1NSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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II ���iL�ld rj i Rough-in Inspection Required? ❑Yes �]No � Inspection OtherThan Rough-In: [�Ready Now �Will Call
i You must call the inspector when ready! 1Date Ready:
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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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Please Provide Two (2) Phone Numbers Including Area Code
\ / \ /
i, Electrical Utility ', Electrical Utility Address
', XCEL EhIE�GY '
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Cpq�r�to�. / qa�}1( �c!w �, j Contraclor nse y{ �[ �� Master Electrician or Power Limited Technician
'� �'lUi41 �tl.�Kt� CORrC1FiATIOhI li � �'J�tfJ �ILicenseNumber
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'� MaiGng Address (Contractor, Company or Owner Performing Installation)
'�300 TEF��;iTORIAL fiOAD, SAINT F'AUL, MN 55114
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Aut� S' nature (Contractor or Owner Performing Installation) — PI �se Pro i Two Ph ne Numbers Including Area Code
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. MSTRUCTIONS ON BACK OF YELLOW COPV BOARD OF ELECTRICITY COPY EB-00001A-15 8.1. 2004