P - 77357REQUEST FOR ELECTRICAL INSPECTION
1�,4 O�- 3 2 8❑8 Minnesota Board of Electricity �os- �/8��% �-
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �,
(651) 642-0800 TTY/MRS 1-800-627-3529 i+�iviv.electricitv.state.mn.us
Describe -using the back of the white copy if necessary - the work covered by this request:
EXCEL ENEF�C�i' SAt�ER `5 SWITCH
GENERAL FEES Outdoor Liahtino Standard (� $1
SUPPLIES
0 to 400
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each $ystem Device or Apparatus @ $.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriqation Boom (a� $40
Traffic Signal Standard @ $5
Supplemental Fee @ $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Su I for Si ns I Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inspection Trips @ $20
Investiqative Fee
uci
TOTAL FEE I� S a �z+�l�A'
(minimum total fee is $20)
I inspected the electrical installation descnbed herein on the dates stated:
— ?� .at� �
SpEC12� �f15 CllOfl $3� p2f HOUf - ExaiREO; aenNOONEO — oATE
Special Ins ction @$.31 per Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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1 IIII II III II i�l II III II III II NI I) III II �I II II) I Ilil
L7813288
��i v�% i�%d� ; Rough-in Inspection Required? ❑Yes �]No Inspection OtherThan Rough-In: [�Ready Now �Will Call
� __ _�i� You must call the inspector when ready! i 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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�,�"%'���a�e��s CIR hIE �c�cvF�FIDLEY
Range
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Niease F'rovltle Two (2) Phone Numbers Including
\ / \ �
tiectticai utipry I Electrical Utility Address
XCEL EME�SGY
�c�`�`�'���'i� t�C CORF'G�iATIGf;I co�t�a�to����se(?��
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� Madmg Address (Contractor, Company or Owner Performing Installation)
'�.�0� TEF:E;IT�f:IAL (iOAD, SAINT F'AUL, h1N 55114
-- —. _ _.
Authorized Si nature (Contractor or Owner Performing Installation) ��le � j
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!�K
INSTRUCTIONS ON BACK OF YELLOW COPV BOARD OF ELECTRICITY COPY
Master Electrician or
License Number
Numbers Including Area Code
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E&0000'IA-15 A'I �nna