P - 80026' REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
� 1-39G-127 � 1821 Universiry Avenue Suite S-�28, 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 XCEL ENER�Y SAVER�S SWITCH
800
IALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus �$.5�
�MULTIFAMILY DWELLINGS (PER
3 to 12 Units �$50 Per Unit
PIVO�
Transformers u to 10 KVA �$10
Transfortners overl0 KVA � $20
Transfortners / Power Supply for Signs / Outline Lighting �$',
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/ar Power Supply up to 500 Amperes, All
Circuits and Two Inspedion Trips Each Dwelling Unit �$80
Additlonal Insoection Tri�s � $20
fOF INSPECTOR USE IXJLV
I heieby certiy thatl
ROUGH IN
FINAI INSPECTION
Fee
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FEE
DATE
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FOFi OFFICE USE ONLY
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Requesi�ate8�2 Rough-in inspection Required? ❑ Yes I�No Inspection Other Than Rough-in: f3Ready Now ❑ Wfll Call
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You must call the inspector when ready! Date Ready:
I certify that I am the I� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wo�C at:
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY