P - 81972REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
� 1-3�]7-47�j � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYIMRS 1-800-627-3529
www. e%ctricity. s ta te. mn. us
Identify the work covered by this request:
O�IEW ❑ REMODEL O ADDITION 0 REPAIR
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CiRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Anuaratus � 5.50
MULTIFAMILY
3to12Ui
Each Add
I Home Park Lots � ;
Vehicle Park SRes �
iding Inspection � $�
�ction � $30 cer Hou
XCEL ENERGY �AVER'S SWITCH
Transformers un to 10 KVA @
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service anci/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
FEE
FON INSPECTOR USE ONLV
I hereby certily that I inspeeted Me elearical inslallation tlescribed herein on Ihe detes siatetl:
ROUGMIN DA'IE
FIN�L INSPECTION /J _ DATE
�
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspectlon Required? ❑ Yes ❑ Inspection Other Than Rough-in: eady Now ❑ Will CaN
Q��1 You must call the inspector when ready! Date Ready:
I certify that I am the �t LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electncal work at: