P - 80014' REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity '�
�-396-135 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTYIMRS 1-800-627-3529
www. electricity. s ta fe. mn. us
IdeMify fhe wodc covered by this request:
UaEW O REMODEL ❑ ADDITION ❑ REPAIR XCEL EMEROY SAVEF�S SWITCH
o to 200
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Ap aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI�
3 to 12 Units �$50 Per Unit
Each AddiUonal Unit � $25
OTHER ADDITIONAL FEES
Liahtina Retrofit � S25 cer Fixture
ro
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Inciudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Insaection Trips (� $20
FOR INSPECTOR USE ONLY
1 hereby c0rtify th
ROUGH IN
FNUL INSPECTION
TOTAL FEE
total fee is $201
herein on tlre dales steted:
l�— vF' e
FOR OFFICE USE ONLY
f IIII�� I�III IIII� III�I �II�I II�� �� �� � I�) ��R/
* 1 3961 354* �_s�
Reque Rough-in Inspection Required? ❑Yes o Inspection Oiher Than Rough-in: Ready Now ❑Nfill Call
You must call the inspector when ready! Date Ready:
I ce�iiy that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electricaf work at:
Jo6 Addressi��' so�� AVE NE °i�' F�p�y zip code ��
Section Township Range Fire No. County /�(�(�(
occu�s�t�E WAYNE L �hone
Power Su_ppier �v Address
]�C�L
Electrica� �qqt�jQ���l�(�,,,,��AT'� Conhactor Lic�{e rlyr�l�l Master License Number
ryuRi i t c: c���n �,P� c���atfa
Mailin9 �r � 1 U! ilA1�YKCJAU � Pb��'►�i�l�`�L,�Y�+IN 55114
Authoriz nature (�ractor, mpany or Owner Performing Installatlon) Phone
�51 ��-2911
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY