P - 80005� REG�UEST FOR ELECTRICAL .NSPECTION
Minnesota Board of Electricity "
� 1-396-116 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642-0800 TTY/MRS 1-800-627-3529
www. el ectricity. sta te. mn. us
Identify the work covered by this request:
O"NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Ap aratus �$.50
ADDITIONS TO THF GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Liqhtinq Retrofit � $25 per Fxture
XCEL ENERQY SAVER'S SWITCH
Outdoor Liahtinq Standard � $1
to 10 KVA � $10
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circufts and Two Inspection Trips Each Dwelling Unit �$f
Additional Insoection Trios � $20
TOTAL FEE
il fee is $20)
roA msaECtoR usE oniv
1 hereby cerlify Mat I inspedetl ttre eleclricsl i`retaNation describeG herein on tlie tlates sTated:
RWGH IN �ATE
FINAI INSPECTION ��'1� DATE
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FOR OFFICE USE ONLY
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Fieque���^� Rough-in InspecNon Required? ❑Yes L�No Inspection Other Than Rough-in: �Ready Now ❑�II Call
You must call the inspector when ready! Date Ready:
I certify that I am the L� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (StL@9t, Bo�AL9QUf@,y� � City F�� . Zip Code �32
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Section Township Range Fire No. County a(�(A
°t�°�i I�EN DIANE C r Phone
Power SuPelier_ ��� A ress
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Electrica► �ont{�tp�,/ ���Iay�R��„rl� Cqntrador Lic�ge �y�g� Master License Number
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Mailing P.�rgsg (��• r�mpany,�r�yop9r' Pprjp�pypgJ[�� I tio�N 55114
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Authorize ' nature (Cypjra�ctor, mpany or Owner Performing Installatian) Phone
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EB-OOOOtA-13 7/1/2000 BOARD OF ELECTFiICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY