P - 80046` REQUEST FOR ELECTRICAL INSPECTION ,
Minnesota Board of Electricity
, 1-396-106 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529
www. e�ectricity, sta te. mn. us
Identify the work covered by this request:
O"NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
401 to 800
0
Above 200 Am ere C� $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 5Q VOLTS
Each S stem Device or A paratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Ligh6ng Retrofit � $25 per Fi�RUre
I I�II�I I�II �III IlIII �II�� U�II �� �� �� 1�
* 1 3 9 6 1 0 6 5*
Reque���2 Rough-in Inspection
XCEL ENEFtQY SAVER'S SWITCH
Traffic Si nal Standard (� $5
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Trensfortners over 10 KVA � $20
Transformers / Power Su I for Si ns / Outline Li htin (� $!
ONE & TWO FAMI�Y DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unft �$80
Additional Inspection Trips � $20
Investigative Fee
Reins�ection Fee � $20
ROUGH IN
FINAL INSPECTION
FOR OFFICE USE ONLY
total fee is
DATE
DATE
�?�
o�0.�b
Required? ❑ Yes C�NO Inspection Other Than Rough-in: �Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certity that I am the L� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address ($tr$st. Bo�p�QqN�,lyp,l �E C� FRIDI.EY Zip Code ���,2
scio � t ri vt
Section Township Ran e Fire No. County A(�(�(A
°cc"�` RTNICZAK ChIRISTIhIE Phone
PowerSu_p Ipier �� Address
7GGEL
Electrica� �,ont�t�L�i�,l1�a��,rl� Contrector Lic�Q�e �y�pq@� Master License Number
i�•it�rv i t c� w t.h u�a�+
Mailing q�r ���ny�� � p�r���g� � tio�N 55114
Authorize ' nature (C�yractor, mpany or Owner Performing Installation) Phone �1 ���„
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E&00001A-13 7/1/200p BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY