P - 77401REQUEST FOR ELECTRI�AL IjySPECTION "
:,.,�
1� 7 81 s 3 5 9 3❑ Minnesota Board of Electricity o{�S (,/� %� �r -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529 x�ww.eleclricity.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL E�IEf;GY SAVER'S ��JITGH
GENERAL FEES Outdoor Lighting Standard $1
SERVICES 1 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 ere $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transformer / Power Su I for Si ns / Outline Li htin $5
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tnps Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units an $50 Per Unit
Lfghting Retrofit @ $.25 per Fixture
Center Pivot Irrigation Boom @ $4C
Menutactured Home Park Lots @ $
Recreational Vehicle Park Sites an'
S ecial Inspection @$.31 per Mile
THIS 1NSTALLATION MAY BE ORDf
I IIII II I� II I�i II I� II III II III il III ��I I) III I IIII
17813593
ction Fee $20
TOTALFEE
(minimum total fee is $20) Z�•S� ��
THIS AREA FOR INSPECTOR USE ONLV
that I inspected the electrical installalion described herein on the dates stated:
� .� o G
DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
i"��L1��(j�j 'ROUgh-inlnspectionRequired? ❑Yes �]No ilnspectionOtherThanRough-In: [�ReadyNow❑WillCall
�_ __ _ 'I You must call the inspector when ready!__ __�Date Ready:
I certify that I am the p LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
—�—t-gf, q—�—s - —__
_. _— _ — T
Joby�V{iV�eS�lll'� D�l �i� . . . ICitY��i'T�� HY
C}Y
���. rownsnip
I- --_.— - - - �------
°�rlYYt�`O€`f'.�"` �6rtAS H
iElectrical Utility
XCEL �NEiiGY
Section
I Please Provide Two (2) Phone Numbers
I,\ / \ �
� r i �q ! Contractor se i Master Electrician or Power Limited Technician-�
I � njC ���'F���IAT�Q� ���J iLicenseNumber
.__. -__ . -- -- - -- --�I �—� .�-- ---
�Mailing Address (Contractor, Company or Owner Performing Installation)
j��GQ TEfi�IT(IC�Ir�L F�OAD, SAIhiT F'AUL, �IN 55114
— — — -- — - --- — — - - — — — — - --
I Authorized Si nature (Contractor or Owner Performing Installation) � PI Pro i wq,� Ph ne Numbers Including Area Code
� �� ,! ��� ���-��i �? ( ) i
IN57RUCTION3 ON BACK OF YELLOW COPY � aoaRn nF Fi FnTRir.iTV cnav �o n���, �,� o, �„�.