P - 81862REQUEST FOR ELECTRICAL INSPECTION
� Minnesota Board of Electricity '�
•� 1-375-399 � 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:
Oi�IEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERALFEES
C
Above 800
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A paratus �$.50
ADOITIONS TO THE GENERAL FEES
3 to 12 Units
Each Additioi
PIVOt
XCEL ENERGY SAVER'S SWITCN
Transfortners over 10 KVA (� $20
Transformers / Power Supply for Signs / Outline Lighting �$!
ONE & TWO FAMILY 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
TOTAL FEE
total fee is $20)
wa
e Park Lots �$25 I hereby certfi/ that I inspected the alectrical installatbn described herein on ihe detes sleted:
10 Pe�lc SitBS �$5 RWGH IN DATE
!ns ection � $20
��O er Hour FlW1L INSPECTION /'+ DATE
� $.31 per Mile ` � - — —�— ZS O�
I III III Illli IINI IIIII II�I �ill Illl�illl IIII Illi
*13753991*
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FOR OFFICE USE ONLY
•
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I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricaf work at: