P - 80059. REQUEST FOR ELECTRICAL 1NSPECTION
Minnesota Board of Electricity
1-396-097 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 ,
(651) 642-0800 TTY/MRS 1-500-627-3529
www, electricity. sta te. mn. us
Identity the work covered by this request:
O'NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTFiOL, SIGP
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A ratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI�
3 to 12 Units �$50 Per Unit
Home Park Lots
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XCEL ENEROY SAVER'S SWITCH
Su lemental Fee � $20
Transfortners u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transfortners / Power Su I for Si ns / Outline Li htin �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$BO
Additional Inspection Trips � $20
Investi ative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20}
Fpp INSPECTOR USE ONLY
ROUGH IN
FINAL INSPECTION
ne.�n on me de�es s�ecea:
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FOR OFFICE USE ONLY
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Requs��1�/Q2 Rough-in Inspection Required? ❑ Yes �No Inspection Other Than Rough-in: IJ(Ready Now ❑ Will Call
You must call the inspeGor when ready! Date Ready:
I certify that I am the [� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address�, s°'c, �°u�� °i�' FRtUL.EY zp �e 55�132
Section Township Range Fire No. County a�(A
o��'R�JFICAN ANN M Phone
972�.
Powar Supplier Address
XCEL EI�V
E����HUIVT E�S�I KICa�RPQRI�IT�Q� Contractor LiceCns�e N_umb�3 Master License Number
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Mailing�r (��gg►��qany,Qr„��r1P�rtpCQ�jppJli t(or�N 55114
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Authorize nature (C ractor, ompany or Owner Perfortning Installation) Phone
�ii e46-2Q� �
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY