P - 75734REQUEST FOR ELECTRICAL INSPECTION �'
'� � � � � � � 7 q, � Minnesota Board of Electricity
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) �9800 TTY/MRS 1-800-627-3529 www.edectricity.state.mn.us
Descn'� -usir�g the back of the white c�pv'rf necessarv - the work covered bv this reauest:
.�r% v�.�Q
GENERALFEES
SE VICES / POWER SUPPLIES
0 to 400 Ampere @$25 l�iG' w
401 to 800 Am re $50
Above 800 Am re $75
CIRCUITS/FEEDERS
0 to 200 Am re$5
Above 200 Am re $10
ALARM, COMMUNICAT10N, REMOTE CONTROL, SIGNALII
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S em Device or A s@$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DVdELLINGS PER UN
3 to 12 Units @$50 Per Unit
Eac� Additional Unft @ $25
OTHER ADDITIONAL fEES
LigMm Retrofit @ $25 r Focture
CeMer Pivot Irrigation Baom @ $40
Manufectured Home Park Lots $25
Recreatlonal Vehicle Park Sit� $5
Bond Ins on $20
Special Insp�tion @,$30 per Hour
Spe�;ial Inspectlon @ $.31 r Mile
THIS INSTALLATION MAY BE ORDERED I
I IIII II �I II �I II I� I I 111 II I� II III � III �� I�
181.12748
Sup lemental Fee @ $20
Transfomrers u to 10 KVA $10
Transfortners over 10 KVA $ 2(1
Transformer I Power Su I for Si r�s / OuU'me U' $5
ONE 8 TWO FAMILY DYNELLINGS, EACH UNR
Includes the Service and/or Pawer Supply up to 500 Ampere.s, All 86� rJ
Circuits and Taro Inspection Trips Each Dwelling Unit @$80 9
� Reinspecfion Fee Q $20
TOTAI
(minimum total fee is
Q� B nusu�ncc
K
I herahv �NN tlmt I It�s�4ed the el�Mml
$20) � �Q�..$(� 8,�.50
iQ15PECfORIlSEOM.Y
mslallafion desafbed herein on the dat� s�ted:
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IF NOT COMPLETED WITHIN 12 MONTHS �
Ft�R pFFICE L5E ONi.Y m�� .,� � 3�is
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I�' Rough-in Inspectlon Requked? �Yes ❑ No I I
2-23-05 �SPedtan Otl�erThan Rough-In: �Ready Now ❑WIA Cell
You must call the Inspector when readyl Date Ready.
I certify that I am the �1 UCENSED COM�RACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the el�;trical work at
Job Site Street Address �Ky
1305 Skywood Lane Fridley
Tawnship Sectlon Range Fire Na. Coimly
OwnedOccupant Name Please Provide Two (2) Phorre Numbe�s Inciuding Area Code
Brickener Builders ( ) ( ),
�a+�ai umny
Xcel Energy
Cor�6actar / Company Name
�,d.ZP.r El�].C, II1C.
Mallin8 Addr�s (Contrector, Company or Owm
8164 Arthur Street N
Authorb,ed p re (Contrador or er P�
�:omracror Ucenae Number Ma�er Electriden or Power
C'A01110 ��"� "°'"�
rform6ig Instellatlon)
, Spring Ialce Park, MI�T 55432
iing I�talletlon) P{�ga de Two (2) Phone Numbeis Incluc
�/E��784-3729 ( )
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anean nF F� Frrairmr rrmv �e .