P - 77746REQUEST FOR ELECTRICAL INSPECTION ��
1����- 3 5 7 5� Minnesota Board of Electricity ;=
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.eleclricitv.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL ENE�;GY SAVEf;'S SWTTCN
GENERAL FEES Outdoor Liqhtinq Standard (� $1
to 800
CIRCUITS / FEEDERS
0 to 200 Am ere ,$5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irrigation Boom @ $4C
Manufactured Home Park Lots @ $
Recreational Vehicle Park Sites (cil'
Supplemental Fee @ $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer 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 Ins ection Tri s $20
Investigative Fee
Reinspection Fee $20
TOTALFEE
(minimum total fee is $20)
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I hereby certity that I inspected ihe elecincal installation descnbed herein on ihe dates stated:
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Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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�. uaie: Rou h-in Ins ection Re uired?
, g p q ❑ Yes [y� No li Inspection Other Than Rough-In: �] Ready Now ❑ Will Call
L��`.%iQQ.r'1 You must call the inspector when ready! � Date Ready:
_.�---- -- ---- -------� ----
I certify that I am the Q LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
��,; Job Site Street Address - �- ��- � � -� — - -
City
I 5�1�4 hiEISTER �,D ��TDI �Y
I Township
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i Section I Range
_-__�__..—___— _.__..._._.
Fire No. I County
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Please Provide Two (2) Phone Numbers
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XCEL EhIEF:GY �_--
Contractor / Company Name Contractor License Number Master Electrician or Power Limited
License Number
�_HUhET ELECTRIC__ CQ�iF'Of,ATIQN---_ . CA 00883
'��, Mailing Address (Contractor, Company or Owner Performing Installation) �-
j L34t} 7�FihITOFiIAL f�QAD„ S�IIhIT F'AUL, MN 5�114
�I Authorized Signature (Contractor or Owner-Performing Ins[allation) � �lease Provide Two (2) Phone Ni
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INSTRUCTIONS ON BACK OF VELLOW COPV aoaRn nF Fi FcraiciTV cnov
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