P - 79753REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
• 1-396-562 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 ` ?
(651) 642-0800 TTY/MRS 1-500-627-3529
www.electricity.state.mn.us ' ��
Identify the work covered by this request:
� IVEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
800 Ampere �
Above 200 Am ere @ $10
ALARM, COMMUN�CATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
TIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per FiMUre
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5 �
Separate Bonding Inspection � $20
Special Inspec6on � $30 per Hour
XCEL ENEROY SAVER'S SWITCH
Transfortners u to 10 KVA �$10
Transformers over 10 KVA � $20
� Transfortners I Power Supply for Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Und �$80
Additional Inspection Trips � $20
Investigative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
FOP INSPECTOF USE ONLV �
i na�eby �mry mec i ���,��ea ma a�� ���nena, d���a nere�o 0o me de�e::m�ed:
flWGH IN DATE
FiNAL INSPECTION /''`� DATE
( ��.2., � • '� G--�`'�
FOR OFFICE USE ONLY
IIIIIIIIIIII�IIIIIIIIIIIIIHIII111111�11�11181 ��
* 1 3965629* ��� �'��
Requesj ��� Rough-in Inspection Required? ❑ Yes �No Inspecdon Other Than Rough-in: �Ready Now ❑ Will Call
You must call the inspector when ready! Date Fieady:
I certity that I am the �! LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Addres���, so��� �� c�ry F��Y z;P coaa
SecUan Township pange Fire No. County
o�c��ISfyN DANIEL M Phone �
Power SuAplle[ �� Address
7�G�L
Electrical Gootracku /�p¢�ty.M�,r'� Contrador Licapgie �IyrpqeL Master License Number
1"IUIY 1 GLt�t 1 tV�i 4rP1 WbG3
Mailing �7W �C1K119LTqJAl.7 � ZIAII'� i"F`� tioMi� �31 i i{
Authorize ' nature (�tract om an or Owner Perfortning Installatlon) Phone �1 6+�6-29�1
�
EB-0OOOtA-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY