P - 77371REQUEST FOR ELECTRI AL INSPECTION '�f'�
1� 7 8 1� 3 6 3 � Minnesota Board of Electricity (,�S �� y� �r-
„ 1821 University Avenue Suite S-128, Saint Paul, Minne�a 55104 - -
`� (651) 642-0800 TTY/MRS 1-800-627-3529 N�n���.electriciry.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL EhlEf�GY SAUER ' S StJ I T(�H
GENERALFEES
0 to 400 Ampere @ $25 �
401 to 800 Ampere @ $50
Above 800 Ampere @ $75
CIRCUITS / FEEDERS
0 to 200 Am re $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Ao�aratus na $.50
to 12 Units @$50 Per Unit
ach Additional Unit @ $25
OTHER ADDITIONAL FEES
qhtina Retrofit C�a $.25 per Fixture
Outdoor Lighting Stand
Traffic Signal Standard
Supplemental Fee @ $
Transformers up to 10 I
Transformers over 10 N
ONE 8 TWO FAMILY DWEL�INGS, 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 (�a $20
IUTALhtt 1,�
(minimum total fee is $20) �U- s� �
ihat I inspected the electncal installa�ion descnbed herein on the dates stated:
L s_�.s
spection @ $30 per Hour ""'"`° "°""°""°"— °"'
spection @ $.31 per Mile
ALLAT{ON MAY BE ORDERED DISCONNECTED_IF NOT COMPLETED WITHIN 12 MONTHS
I I�I ��i U i� I) ui II IN � lli l! IN N Iil ll iil l lIII
178�3635
��, u�[e;�� f� � 'I Rough-in Inspection Required? ❑Yes �] No �I Inspection Other Than Rough-In: [kReady Now �Will Call
is �
� I You must call the inspector when ready! I Date Ready:
I certify that I am the �1 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
— - - - _ _ ____________----
Job ite treetAddress � rCity
_��� �TE�F��s�� s-r r�F � F�zn��r
����AMUP���SALAhi
� Section I Range � Fire No.
_ _ _ __ __ _ ___ ___
' Please I
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ar�aKa
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! Electrical Utility '�, Electrical Utility Address
�, XCEL ENERGY �
� C ntractor / Compan Name � � i Contractor nse r i Master Electrician or Power Limited Technician
,�ur�T ELEG�Tf�ZC ca�F���arr.or� , i�� �'�`��,� i���e�SeN�mbe� i
~---____ _ _ _ _ - - - - - - -- - � - _ _ __ _ _ _ __ L _ ____ _ ______ _ -- j
Mailin9 Address (Contractor, Company or Owner Performing Installation)
��344 TE:RRITdRIAL ROAI3, SfisIhIT F'AUL, �!N 55114 �
�------ — --= —=--- ---------- �
Aufhorized Sigeature (Contractor or Owner Performing Installation) I Please Provide Two (2 Phone Numbers Including Area Code
i`7��4 —'(��� ��a�-; ��� � � �
INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY EB-00001A-15 8.1. 2004