P - 80049� REQUEST FOR ELECTRICAL INSPECTION �.
Minnesota Board of Electricity R�'�
1-396-110 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TiY/MRS 1-800-627-3529
www.electriciry.state.mn.us '
IdentiTy the work covered by this request:
0"NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR XCEL ENERt3Y SAVER�S SWITCH
GENERAL FEES Outdoor Li htin Standard �$1
SERVlCES I POWER SUPPLIES Tratfic Si nal Standard �$5
0 to 400 Am ere (� $25 Su lemental Fee �$20
401 to S00 Am ere �$50 Transfortners u to 10 KVA �$10
Above 800 Am ere �$75 Transformers over 10 KVA �$20
CIRCUIT5/ FEEDERS Transfortners / Power Su I for Si ns / Outline Li hNn �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up to 500 Amperes, Ail
ALARM, COMMUNICATION, REMOTE CONTROI, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS Additional Inspection Trips �$20
Each S stem Device or ratus �$.50 �nvesti ative Fee
ADDITIONS TO THE GENERAL FEES Reins ection Fee �$20
MULTIFAMILY DWELLINGS PER UNI� TOTAL FEE
3 to 12 Units (�1 $50 Per Unit (minimum total fee is $20)
ADDITIONAL
Manufactured Home Park Lots � ;
Recreational Vehicle Park Sites �
ROUGH IN
FINAL INSPECTION
Eeacribad herein an Me detes sl
DATE
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�T �. �..
FOR OFFICE USE ONLY
I�II�■� � IIII� IIIII �II,1 I�II IIIII ���11 III) ��II ��-�n �_ V
* 1 3 9 6 1 1 0 7* �"S
Reque�J�/�2 Rough-in Inspection Required? ❑ Yes [J(No Inspection Other Than Rough-in: �jReady Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certify that I am the L� LICENSED CONTRACTOR ❑ COMPANY O OWNER arni hereby request inspection of the electrical work at:
Job Address��, so���v� � c��' FRIC7LEY Z�P � 5fr132
Section Township Range Pire No. County AN�KA
°�°��S ALICaE B • � PFwne
Power S�� E�Y Address
ElectriG�l Gqp �at cfp� /, 1`.q�pppy,pl�qp„�,.,,�,., �.�� Contractor LicBpgp JyWpq�� Master License Number
1"1VIY 1 GL.C4� I Rlli 4uR�JRf� lsH Wq{1
Mailingq�l�ais��P�ny���r�P�i�g� � ti�N 55114
Authoriz ' nature (�ractol ompan or Owner Perfortning Installation) Phone �1 Q�B-2911
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EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY