P - 77336, REQUEST FOR ELECTRICrp,L IN ECT ON °� �
1� 1 V�- 3 7 4❑2 Minnesota Board of Electricity �(/i�)��/� � �r- -
1821 University Avenue Suite S-128, Sain{p u� innesota 5 1 4
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.stute.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL EhIEC;GY S�,�lER `S S4JSTCH
GENERAL FEES Ouldoor Liohtino Standard (� $1
0 to 400 Ai
40t to 800
UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
fIFAMILY DWELLINGS (PER UNIT)
3 to 12 Units @$50 Per Unit
Center Pivot Irrigation Boom
Manufactured Home Park Lc
Supplemental Fee @ $20
Transformers up to 10 KVA @$10
Transformers over 10 KVA al� $ 20
ONE 8 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
Investigative Fee
Reinspection Fee
TOTALfEE
total fee is $201 a�-3���
I inspected the electrical installation descnbed herein on the dates stated:
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THI5INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
I IIII II I� II I� (I Itl I) � II III II III II I� �I I� I IIN
1 7 8 1 3 7 4�
I ���,^L� f(� � I Rough-in Inspection Required? ❑Yes �] No � Inspection Other Than Rough-In: [�Ready Now ❑Will Call
iL _ ._ _. �I You must call the inspector when ready! _ �I Date Ready: __
I ceRify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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,�°pi���.``�ilA`�`��IU&E RD arvFf�IDLEY
I I I I --.._....
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'I OwryqrlQccUparyt,pla�R��� E � I Please Provide Two (2) Phone Numbers
, LU�'IC i`I t.UKU I � ` � `
� �
: ElecVical Utility Electrical Utility Address
' XCEL EhtE�;GY
� C r / t� 1 ' Contrector ��G nse r�y �Master Electrician or P
��� ��� I�C CQ(iF�O�it'�TI �lhl � Lt� ��ti�J I License Number
I�
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' Mailing Address (Contractor, Company or Owner Performing Ins[allation)
i �3��4 TE�if,ITORIAL nOAD, SAINT F'AUL, I�hl 55114
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, Autho�izod S' nature (Contractor or Owner Performing Installation) PI Pro i e TwQ�( Ph ne Numbers
I ��� I�.�i� ��6-L�1� � �