P - 79761� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
, 1-396-538 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us '
Identify the work covered by this request:
� f�EW ❑ REMODEL ❑ ADDITION O REPAIR XCEL ENER4�Y SAVER�S SWITCH
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Trattic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
40i to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 600 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformers / Power Su I for Si ns / Outline Li htin �$'
0 to 200 Am ere Q$5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere C� $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unft �$80
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS Additional Inspection Trips �$20
Each Svstem Device or Aooaratus �$.50 InvestioaNve Fee
AILY DWELLINGS (PER UNI�
2 Units � $50 Per Unit
Additional Unit � $25
OTHER ADDITIONAL FEES
n Retrofit � $25 er Flxture
ir Pivot IrrigaGon Boom l� $40 �
factured Home Park Lots � $25
iational Vehicle Park Sites � $5
rate Bonding Inspection � $20
al Inspection � $30 per Hour
1 hereby certiy that I
HOUGH IN
FINAL
total fee is
the electricalinstallation described herein on the detee steted: I
DATE
r� �
_ _ _ _...�, ` . ' ' " _ _ " "_ . _ . ' ' "" _ ' _ " " ' ' '
FOR OFFICE USE ONLY
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Reques� ��� RougA-in Inspection Required? ❑ Yes ['�,No Inspection Other Than Rou h-in:
You must call the in 9 �Ready Now ❑ Will Call
spector 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�et, Box qz �i�y�p ap,�
�96'1 g I f 1 � I IYC ��� �'� ZiP Cade
Section Township �1
Range Fire No. County A�A
� MAST �i� ('i Phone
Power S�I'�_
� � Address
�T'� ConTractor Lic� �y�p�� Master License
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; "S�Vi91g1� ' ����IN 5519 4
��i� � -_—._....y .......,,�a.���q Phone
s-0000, n-, s �n n000 8�''i1 ��-2911
BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY