P - 77363' REQUEST FOR ELECTRICAL INSPECr,TION �,��".' �
1 � � V � - 3 4 2 9� Minnesota Board of Electricity �('�S - � �OSQ '' - �e``�_ '
1821 University Avenue Suite S-128, Saint Paul, Minnesota 59�104 ��:
(651) 642-0800 TTY/MRS 1-800-627-3529 �a�ia�i��.eleclricitv.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL ENEF;GY SA'JEE:'S S�IITCH
GENERAL FEES Outdoor Lighting Standard @$1
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
0 to 400 Ampere @$25 Supplemental Fee @$20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li htin $5
0 to 200 Am ere $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Inspection Tri s $20
Each S stem Device or Apparatus @$.50 Investigative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee (cil $20
3 to 12 Units @ $50
Each Additional Unit
�fit @ $.25 per Fixture
Imgation Boom @ $4C
I Home Park Lots $
Vehicle Park Sites na ,
that I
TOTAL FEE
total fee is $20) � •S� '�- ' °�
ihe electrical inslailation described herein on �he dates stated:
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Special Inspection @ $30 per Hour =_xaieeo aan��coNeo � • � 3TE � `
Special Inspection $.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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1781,3429
�Q � i� Rough-in Inspection Required? ❑Yes 0 No I Inspection Other Than Rough-In: � Ready Now ❑Will Call
.__ Lou must call the inspector when ready! �I Date Ready:
I certify that I am the !� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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I Job Site S et Address �� � --� �-- -� �� -- -- -- - - -
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, Township � -� Section i Range :,, Fire No � C�
AhiC�KA
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i OwnerlOccupant Name � � - — -- ` - -
� wo (2) Phone Nt
I t_O5l�ESS ANN �; � � �
; Electrical Utility � � � ,' Electrical Utility Address � � --
', XCEL ENEfiGY
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- Contractor / Company Name � '�, Contractor License Number Master Electrician or Power Limited Technician
', Nl.1hIT ELECT�'iIG C��:F'OF;ATIUI�{ [:� {1(�}�js�j LicenseNumber
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I�Mailing Address (Contractor, Company or Owner Performing Installation) -� �- �� --� -�
I�a40 TEf;F:ITDF�IAL RGAD, �AIhlT �'�L1L, f�N 55��,/�
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Autborized Signature (Contractor or Owner Performin Installation -� - �-- � - � -- -
9 ) �. Please Provide�Two (2) Phone Nu
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INSTRUCT70�lS ON ACK OF VELLOW COPV � BOARD OF ELECTRICITV COPY
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