P - 77359REQUEST FOR ELECTRICAL INSPECTION �°�
1�� V-� - 3 2 9 6� Minnesota Board of Electricity y�(�S -Q���� �-
� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
�= (651) 642-0800 TTY/MRS 1-800-627-3529 wwH�.electricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL ENERGY SAt1EF;'S St�ITCH
I POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus (�a $.50
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
� Retroft @ $.25 per Fixture
Pivot Imqation Boom Ca� $4f
Traffic Signal Standard
Suoolemental Fee a(� $
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
Investiqative Fee
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total fee is $20) � • �b xvre�tt
I inspected the electncal installation descnbed herein on the dates stated:
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Spedal Inspection $30 per Hour `""'"`° ""F"°°"`L °""
Special Inspection @ $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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17813296
u�riL�r(}�y I Rough-in Inspection Required? ❑Yes �] No � Inspection OtherThan Rough-In: [�Ready Now ❑Will Call
IYou must call the inspector when ready! I Date Ready:
I certify that I am the [7�1 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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i�°�'��tfe%I�ii�lhl AVE I`IE c��vFRIDLEY
ITownship I Section
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I Range I Fire No. � County �rj�j�(�
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�Please Provide Two (2) Phone Numbers Including Area Code
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', Eectrical Utility �Electrical UtilityAddress
� XCEL EhIEFiGY
�II Cpr�p��qc !�pr/�par}yy�q I Contracrorl,� se p� !Master Electrician or Power Limited Techni�
I"IUF`!t CLtl..ICtil�. �D�iF���I�T��i� ' l.� ���3� iLicenseNumber
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' Maifing Address (Contractor, Company or Owner Performing Installation)
'; �3G0 TERF�IT�F;IAL f;DAD, SAIhIT F'AUL, h#N 55114
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� Aulhorized Si na�tur�rntractor or Owner Performing Installation) ' PI 3s Pro i w Ph ne Numbers Including Area Code
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