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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: �re :<.�.s-H �� �• - /_ ��� IF NOT COMPLETED WITHIN 12 MONTHS � Ft�R pFFICE L5E ONi.Y m�� .,� � 3�is � � ���� � 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 ( ) d anean nF F� Frrairmr rrmv �e .