P - 773531,�-781-315 5❑
the white copy
I POWER SUPPLIES
�
REQUEST FOR ELECTRICAL INSPECTION `��`�,
Minnesota Board of Electricity ��OQS- � 1Q`��'% *-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.stale.mn.us
- �he work covered by this re uest.
=L ENERGY SAV�f;`S 54JITCH
Outdoor Lighting Standard @ $1
Traffic Signal Standard @ $5
CIRCUITS / FEEDERS
0 to 200 Am ere $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus C� $.50
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liahtinp Retrofit c(� $.25 oer Fixture
Rec�eational Vehicle Park Sites
Fee @ $20
up to 10 KVA @ $10
overl0 KVA @ $ 20
Power Suoolv for Sians / Outline
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
Fee
Fee
TOTALFEE v �
total fee is $20) � � S
ihat I inspected lhe elecirical inslallation described herein on the dates stated:
�� � � l .. ��
Special Inspection @$30 per Hour `""'"°° "°""°""`� °"" I
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
IIII II I� II I�! II III II Ili II I� II III ii HI II IN I IIII
17813155
�I ���� �,� c �� Rough-in Inspection Required? ❑ Yes �] No �I Inspection Other Than Rough-In: [,�Ready Now ❑Will Call
I You must call the inspector when ready! Date Ready:
I--.—._— ._------- ----- . . �---.
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Jo ySie — — --- _ — — --- --- -- — — �City�rti����i
i i�i`� ��1��,�"Y ST hiE I
' Township I Section I Range
i
� — -- ._._. .---�L-- — —�— — — —
!°�"�`�'i���Na�'�THRINE E
I Fire No. I County ���Q K�
li Please Provide T I o(2) Phone Numbers Including Area Code
� � � �
' XCEL ENEF�GY I
i— — — _ ---- -- ---�
��IC42(���/C,Qrp�r�yLy�n�C �O�F'��p�I�� ��.Contractorl,�e^�nse,�Jyrr�p�� �erElectricianorPowerLimitedTechni�
�"I1.7 ti_ l. � h; l.. �)tlt:3 .3 I License Number
�-------. . __ . _— — — —___— . I_—__ —. _ _ — _ __1--- . . _— —
, Mailing Address (Contractor, Company or Owner Performing Installation)
;^�44 TEf;C�IiORIAL �DAD, SAIt�ET F'AUL, MN 55114
�-------- - '--- —_---� --- — -
, Authorized Signature (COnhactor or Owner Performing Installation) Please Prowde Two 2 Phone Numbers Including Area Code
� � � �� (as� ���-��� � ( )
_� -- -- — —
INSTRUGTIONS ON BACK OF YELLOW WPY BOARD OF ELECTRICITV COPY EB-00001A-15 8.1.