P - 80004REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-115 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642-0800 TTY/MRS 1-500•627-3529
www.eleciricity.state.mn.us ' � �
Ideniiiy the work covered by this request:
�EW ❑ REMODEL ❑ ADDITION ❑ REPAIR XCEL ENEROY SAVER'S SWITCH
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Tramc Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transiormers u to 10 KVA �$10
Above 800 Am ere �$75 Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Transformers / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 QNE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere (� $10 Includes the Service and/or Power Supply up to 500 Amperes, All
AIARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Gircuits and Two Inspection Trips Each Dwelling Unit �$BO
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS Addi6onal Inspection Trips �$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20
MULTIFAMILY DWELLINGS (PER UNITI TOTAL FEE ,
C� $25 I I FOR INSPECTOP USE ONLV
�S � '�C ROUGH IN
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�.{n�� � � � FINALINSI
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a� me ae�es smceo:
DATE
. FOR OFFICE USE ONLY
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Reque�8��� Rough-in I�spection Raquired? ❑ Yes [�No Inspec,Yion Other Than Rough-in: I�Ready Now ❑ v�nn can
� You must call the inspector when ready! Date Ready:
I certity that I am the I� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he�eby request inspection of the electrical work at:
Job Address (S�, so�9c�,x n� � c�� ��� zP coae �3
Section Township Range Fire No. County p�F(A
o�u��P{ DANIEL E P�18
Power Supplier r
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Electrical �oM� y;� _�ny� �me ���,�,I�� Contractor Lice�n,s�e �� Master License Number
f�ili t �:TRi �O
Mailing qQ�jrg�g j�,ppti�(q�,��p�ny9r�yap�r1P�rjpjQijqpJ�;t I tio�N 55114
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Au[horize ' nature (C�ractor, ompany or Owner Perfortning Installation) Phone
��' �51 B46-ZS11
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INS7RUCTIONS ON BACK OF YELLOW COPY