P - 80058REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity e
1-396-099 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 '
(651) 642-OS00 1TY/MRS 1-800-627-3529
www, electricity. state. mn. us
Identify the work covered by this request:
�f�EW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
TIFAMILY DWELLINGS
3 to 12 Units �$50 Pe
$25
XCEL ENEROY SAVER'S SWITCN
Transfortners over 10 KVA � $20
Transfortners / Power Supply tor Signs / Outline Lighting �$!
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes Ihe Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit C� $80
Additional Inspection Trips � $20
i nerecy ceRay met i
ROUGH IN
FINAL INSPECTION
TOTAL FEE
total fee is $20)
DATE
DATE
\ �G
FOR OFFICE USE ONLY
I Iili� iHli a�l !IlII NIII Ilill lilil ��i �l! !�i �?.�
* 1 3960992'' �p.sd
Reque Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-in: Reatly Now ❑�II Call
You must call the inspector when ready! Date Ready:
I cert'rfy that I am the �i LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
E&00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCliONS ON BACK OF YELLOW COPY