P - 77386a
p REQUEST FOR ELECyRI��A� �����ON
1�� O�- 3 5 0 2� Minnesota Board of Electricit o� ;r-r
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 wivx�.eleclricity.slate.mn.us
-using tne DacK ot the whrte copy it necessary - the work covered by this request
EXCEL EhlERGY SAVEFi'S SWITCH
GENERALFEES
I POWER SUPPLIES
;M, COMMUNICATION, REMOTE CONTROL,
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus an $.50
2 Units @ $50 Per Unit
Additional Unit Q $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriqafion Boom (cil $40
Traffic Signal Standard
Supplemental Fee (� $
over
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
total fee is $20) c�i� •5��'�
I hereby certify that I inspected the elecMcal installation descnbed herein on the dates stated:
/ � Z �L O
Special Inspection @$30 per Hour ExaReo nenruooNeo--- oarE
Special Inspection @ $.31 per Mile
THIS 1NSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
�
I IIII II III II I� II I�I II I� II III II III II III II � I�II
1 7 8 1 3 5 0�
�, "�f ^l�l4 �y ''�, Rough-in Inspection Required? ❑ Yes �] No '�, Inspection Other Than Rough-In: [�Ready Now ❑ Will Call
�
�� ' You must call the inspector when ready! � Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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�°$�.'�i�.t` t�i�`�IBOW D(i - a�vF�iIDLEY
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', °�'���i �L`�i�e NORITfAM R
County
. _ .. _ — � � - --� —
'i Please Provide Two (2) Phone Numbers
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a� �����y �.. ciecmcai �nnry Haaress
XCEL EhIEhGY
qq�ry�(o�.C,p�qar}yJ�l�ng —�--
CI"IUi41/ �Ltl.itCl� C��lF'OF{ATZOi*) '�Contractor��nse,[Jy{rta¢g{�. MasterElectricianorPowerLimitedTechni
ta V tf tYJ �License Number
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, Mailing Address (Contractor, Company or Owner Performing Installation) ��
���0� TEFR�TOf�IAL Rt7AD, SflIhiT F'AUL., MN 55114
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i Authorized Si nature (COntractor or Owner Performing Installation) ' PI a e Pro i wo„{ Ph� ne Numbers Including Area Code
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INSTRUCTIONS ON BACK OF YELLOW COPY pnaRn nF Fi FcraiciTV cncv �o �,,.,,,, .. .� e,