P - 80020° REQUEST FOR ELECTRICAL INSPECTION
r Minnesota Board of Electricity
, 1-396-131 3� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn. us
Identify the work covered by this request:
�NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR XCEL ENEROY SAVER�S SWITCH
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traific Si nal Standard �$5
0 to 400 Ampere �$25 Su�olemental Fee �$20
0 to 200 /
Above 2a
ALARM, COMI
CIRCUITS. CIF
Each S s
MULTIFAMILY
� $5
re�$10
�TION, REMOTE CONTROL, SIGNALING
OF LESS THAN 50 VOLTS
Boom
�
,�
a.,�;.w
, �l:
ONE 6 TWO FAM{LY DWELLINGS, EACH UNIT
Includes ihe Service and/or Power Supply up to 500 Amperes, All
Circufts and Two Inspection Trips Each Dwelling Unft �$80
Additional Insoection Trios � S20
wn iresvecTOa use a+iv
I herebvi ceNN that I
FlNAL
TOTAL FEE
the eleclrical instaNalion dasc'ibed harein on Ma dales slated:
DATE
S ecial Ins 'on Q$.31 r Mile � ��_.�°�--- �%� ���� �
_—__Ikll� INSTALLATION jiAAY BE O�F.FIED DI$GQ NECIEQIF i�QM�ILWITHIN 18 MC1NTJiS_ _
FOR OFFlCE USE ONLY
( IIIIII IIIII III1I filll Iflll �II)1lifl ��� I�I � 755,�
*13961313* �Sp
Reque��2 Rough-in Inspection Requfred? ❑ Yes l�[NO Inspectian Other Than Rough-in: Q(Ready Now ❑ WIII Call
You must call the inspector when readyl Date Ready:
I certify that I am the C� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
EB-00001A-13 7/1/2000 BOARO OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY