P - 79292❑ REQUEST FOR ELECTRICAL INSPECTION
�.� ( 1 J- 5 4 3 2 Minnesota Board of EleCtricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TIYIMRS 1-800-627-3529 www.electricity.state.mn.us
C3 NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy it necessary - the work covered by this request:
XCEL Ei�1ER�Y S�;V�R'S SV�IiT��°i
GENERAL FEES Outdoor Lighting Siandard @$1 ____
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACN UNIT
Above 200 Am ere $10 Includes the Service and/or Power Supply up to 500 Amperes, AI!
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Tnps Each Dwelling Unit @ E80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Inspection Trips @$20
3 to 12 Units �$50 Per Unit (minimum total fee is $20) � �2D.50
Each Additional Unit @$25 tws n�n roa uavECrat usE orar
I he2by cer6fy that l inspec0ed tlie electrical inSWlagon descxibed herei� on tl�e da�s sta�d:
OTHER ADDITIONAL FEES
aZ o� � -- G'l �% z
I inMinn Retrr�f klr A 95 nwr FiYture
11i11� �� i� 1� �� ��� i�� i� i�� �� ��� �����I �I ��� ��
�
L773543�
_(7.e
R 5271
,. a �
Request Date: Rough-i� Inspection Required? ❑ Yes Inspection Othef Than Rough-In: �Abady Now � VYAI Call
Q�j�J(� You must call the inspedw when ready! Date Ready.
I certify that I am 1he C�.ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER a� hereby request inspection of the electrical work at:
INSTRUCTIONS ON BACK OF YELLOW COPV BOARD OF ELECTRIC(TY COP`/ . �°^"^"�'^"� °''' `""`