P - 80019REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
, 1-396-132 1' is21 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity.state.mn. us
IdentiTy the work wvered by this request:
0'I�EW ❑ REMODEL ❑ ADDITION ❑ REPAIR XCEL ENE�tOY SAVER�S SWITCH
GENERAL FEES Outdoor Liahtina Standard � S1
Above 800
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or paratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNITI
Unit � $25
OTHER ADDITIONAL FEES
� $25 per Fi�Rure �
�ation Boom � $40
�me Park Lots � $25
iicle Park Sites � $5
ig Inspection � $20
m � $30 per Hour
x� � $.31 cer Mile
Transfortners u to 10 KVA �$10
Transfortners over 10 KVA � $20
TransSormers / Power Supply for Signs 1 Outline Lighting �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellinp Unit �$E
, � � FOR INSPECTOF USE ONLV
Fee �
�;��„ >
,•'�' .:,� ;
TOTAL FEE
d fee is $201
I hereby certify tha[linspecled Me electncalinstallation tlescnbetl herein on the dates slated:
RIX1CH IN DATE
FINAL INSPECTION � OATE
���_... �- —if.. O�
FOR OFFICE USE ONLY
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II I I Ill� �III IIIII Ilill II�I IIIII � l� I�I
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* 1 3961 321 * �5.�
Reque���2 Rough-in Inspection Required? ❑ Yes C�No Inspectlon Other Than Rough-in: � Ready Now ❑ Will Call
You must catl the inspector when ready! Date Ready:
I certify that I am the �9 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address��g►, Bo�o�qp�y�lq,�� City �� Zip Code ��,�,
r �s��rtr�t riu
Section Township Range Fire No. County p�(A
�
Occup,�M�TM ��Q � Phone
Zi
Power Su lier ��Y Address
ElectricaJ �q2t���q�y��lt�ngR�AT�� Contractor LicgCge tlyrqbgi Master License Number
riurv i t �. � rKic: <<U �.,A t�a�i;i
Mai�ingAd�B�,s�IUFiI�y�AU�P�i���i�lU���iiiN 55114
1'.30t1
Authoriz ' nature (�ractor, ampeny or Owner Performing Installatlon) Phone
651 �4�-2911
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY