P - 81979� REQUEST FOR ELECTRICAL INSPECTfON
Minnesota Board of Electricity
� 1-377-487 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 _
(651) 642-0800 TTY/MRS t-800-627-3529
www.e%ctricity.state.mn.us '
Identify the work covered by this request:
O�IEW ❑ REMODEL ❑ ADDITION ❑ REPAIR XCEL ENERGY SAVER�S SWiTCH
GENEfiAL FEES Outdoor Li hti Standard �$1
SERVICES / POWER SUPPL�ES Traffic Sional Standard �$5
IALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
� Each Svstem Device or An�aratus (� 3.50 �
I MULTIFAMILY
Su lemental Fee � $20
Transformers u to 10 KVA �$10
Transformers overl0 KVA � $20
Transiormers / Power Su I for Si ns / Outline Li htin �$!
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 50� Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
FOF INSPECTOR USE ONLV
I hereby certifythatlinspectetl the elecfrical
ROUGHIN
FINqL INSPECTION ���,..... /
total
DA7E
DATE
� S -� (
FOR OFFICE USE ONLY
i iii�i iii�i Niii iiiii i��ii i�i� �ii � i�i �°'sa ,.
* � 3��48�2* ��3�d
Request Date: Raugh-in Inspection flequired? ❑ Yes ❑ Inspection Other Than Rough-in: eady Now ❑ Will Call
Q%/Q$/Q� 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: