P - 81982� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
' 1-377-490 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 _
(651) 642-0800 TTY/MRS 1-800-627-3529
www. e(ectricity.state.mn, us
Iden[ify the work covered by ihis request:
O:IGEW ❑ REMODEL ❑ ADDITION O REPAIR XCEL ENERGY SAVER�S SWITCH
GENERAI FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su leme�tal Fee �$2�
401 to 800 Am ere �$50 Transfortners u to 10 KVA �$10
Above 800 Am re �$75 Trans(ormers overl0 KVA �$29
CIRCUI7S / FEEDERS Transfortners / Power Su I tor Si ns / OuUine Li hti� �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLfNGS, EACH UNIT
Above 200 Am ere �$1� Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two InspecGon Trips Each Dwelling Unit �$80
CIRCUITS. CIRCUITS OF �ESS THAN 50 VOLTS Additional Inspection Trips �$20
Each S stem Device or A paratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ectlon Fee �$2�
MULTIFAMILY DWELLINGS (PER UNI TOTAL FEE �
3 to 12 Units �$50 Per Unif (minimum total fee is $20
Fnrh ArlAifinnnl Ilnit � C�S FONINSPECiOFUSE�lI.Y
Center Pivot irrigation Boom � $40
Manufactured Home Park Lois � $1
Recreational Vehicle Park Sites � 9
Separate Bonding Inspection � $2C
Special Inspection � $30 per Hour
1 hereby certity ihat I inspected Me electrical
ROUGH IN
FINAL INSPECTION �� �
OATE
DATE
� Z �
FOR OFFICE USE ONLY
i �ai�ii�ii��ii�ii���i��ii�� a°'s ° •
i«i�i�
* 1 3774906" '��b
Request Date: Rough-in Inspection RequiredT ❑ Yes ❑ Inspection Oiher Than Rough-In: eady Now ❑ WiU Call
�7ro��j You must call the lnspector when ready! Date Ready:
I certity that I am the L� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, 8ox, ar Route No.) Ciry Zip Code
Section Township Range Fire No. Cou�1Y
AMaM(A
Occupant .� ..� .. _ _ Phone
� Mailing
- --- - - Address
eny ams
;.� T,�F If CDRP�R/I
, Company or Owner Performing
tITOR�At ROAQ _
actor. Comoanv or Oxmer Per�or
License
Phone
License
EB_�001 _ � BOAFD OF ELECTRICITY COPY INSTRUCTI��OIT�iIL�K�bFV�LLOW COPl