P - 80042� A REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
� 1-396-109 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TfY/MRS 1-800-627-3529
www. electriciry, sta te. mn. us
Identify the work covered by this request:
OT7EW O REMODEL ❑ ADDITION ❑ REPAIR XCEL ENERC3Y SAVER�S SWITGH
401
Above 2�U Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
�T Each Svstem Device or Aooaratus � 5.50 �
ta 12 Units �$50 Per Unit
Center Pivot Irtigation Boom � $4(
Manufactured Home Park Lots � $
Recreafional Vehicle Park Sites �
Separete Bonding Inspection 0 $'L�
Special Inspection � $30 per Fbur
Special Inspection � $.31 per Mile
Transfortners u to 10 KVA �$10
Transfortners over 10 KVA � $2�
Transfortners / Power Supply for SiQns / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
lncludes the Service andlor Power Suppry up to 500 Amperes, All
CircuRs and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips � $20
Investi ative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
FOfl INSPECTOF USE ONLY
i nereoy cemy ma� i
RWGH IN
FINFL INSPECfION
DATE
DATE
.� L�� ^�
FOR OFFICE USE ONLY
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I i� I IIIII pl� IIIII �III II� �lll �q I�l
*,396,099* ao.Sa
Reque�IJ��/�'Z Rough-in Inspection Required? ❑ Yes �Na Inspection Olher Than Rough-in: �Ready Now ❑ Will Call
You must call the inspector when readyl Date Ready:
I certify that I am the L� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Sir�aW, Bo�,X1�� NE C�� FRiC1L.EY Z�p �e �
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Section Township Range Fire No. Counry A�{/�
OccuP�uC�lii�F �ui�l � 2 9 Phone
Power Su plier �� Address •
Electrical �u t_ �tE• �o���a���TION Contractor �ice� N�mpg3 Masrer �icense Number
hi IV I �E tftl
nnailin9 yp� fl� �p���ny�o v�r,P�rfp�g��t I tio�N 55114
I.dW A A
Authorize nature (C�ractor, mpany or Owner Performing Installation) Phone
651 6�6-2�11
E&00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY