P - 81980�-
' REQUEST FOR ELECTRICAL INSPECTION
* Minnesota Board of Electricity ��
�-37%-�$$ � 1821 University Avenue Suite S•128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. sta te. mn. us
Identify the work covered by this request:
O�IEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
IZ�I�I�:�
to
� CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
� Each Svstem Device or Aooaratus �$.50
Home
ADDITIONAL
$1185 �
Oft � $:
XGEL ENERGY �AVER'� SWITCH
Outdoor Lighting Starxiard � $1
Traffic Sianal Standard � $5
Transformers u to 10 KVA �$10
Transiormers over 10 KVA � $20
Transformers / Power Supply for SiQns / Outline Lighting �$!
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circufts and Two Inspection Trips Each Dwelling Unit �$80
Addifional Inspecdon Trips � $2�
Investiaative Fee
FOfl INSPECTOP USE ONLY
i ne�envi ceniry ma� i
ROUGH IN
fINAL INSPECTqN
TOTAL FEE
d fee is $20)
DATE
DAlE
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----- ---------------- ••---• -- -•---- -----•°-- -- - ----- -- ---- - - �
FOR OFFlCE USE ONLY
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* 1 3774880* '��� ��.�-�
Request Date: Rough-in Inspection Required? ❑ Yes ❑ Inspection Other Than Rough-in: eady Now ❑ Will Call
07%��jro� You must call the inspector when readyt Date Ready: �
I certify that I am the L� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electncal work at: