P - 79758� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
� 1-396-548 �' �82t Universiry Avenue Suite S-�2e, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY/MRS 1-800-627-3529
www, electricity.state.mn. us
Identity the work covered by this request:
�ILEW ❑ REMODEL ❑ ADDITION ❑ REPAIfi XCEL ENEROY SAVER'S SWITCH
�
800
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THF GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additional Unii � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 er Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$25 A�.
Transfortners over 10 KVA � $20
Transfortners ! Power Suppry ior Signs / Outline Lighting (�
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$E
Additional Inspection Trips � $20
Fee �
Mat I inso�c[ed the
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TOTAL FEE
total fee is $20)
nw�oauwwi veni�ro rarK,rtes �21 y� � � r► �•w��Li — on�
Se arate Bondin I ection �$20 r-��-� '3 � 1j/�
S ial Ins ion �$30 er Hour .mrz
S ecial Ins ection � $.31
THISINSTAI'�--------------------- -
� FOR OFFICE USE ONLY
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Reques� ��/Q'2 Rough-in Inspection Required? ❑ Yes IRNO Inspection Other Than Rough-in: IRReady Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Addres�, so�� � cay FR��Y ZP �e �
SecNon Township Range Fire No. County
occu�NT ISA�L O n� Phone
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Power S�ulGlie[ E� Address
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Electrical 6oGfWCGar./.Ccwau�v.il�q,,..,.,r�.,,..r'� Contrector Licap;ed4unheL Master License Number
11UIY 1 CI_C�. f Ki�. wr�r��r�r�► \►P1 WtltlJ
tv�ailing ��`���i F��9�'J�I�i�°N�IN 55114
Authorize ' nature (�tract�q� om an or Owner Pertortning Installation) � Phone �, 5��,
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E&00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY