P - 80012REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
-396-137 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
� (651) 642-0800 TTY/MRS 1-800-627-3529
www.e%ctricity.state.mn, us
Identity the work covered by this request:
O�IEW ❑ REMODEL ❑ ADDITION
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS I FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGP
CIRCUITS. CIRCUITS 0� LESS THAN 50 VOLTS
Each System Device or A aratus �$.50
ADDITIONS TO THF GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI
3 to 12 Units � S50 Per Unit
Fixture
XCEL ENERQY SAVER'S SWITGH
ONE 8 TWO FAMILY DWELLWGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips � $20
FOfl INSPECTOR USE ONLV
1 hereby cenity Mat I inspeCled MB electrical inMellation
flWGH IN
FINAL INSPECTION .
AL FEE a(j,�
is $20
dn on ihe datea steted:
DATE
DATE
--{�_ 3/_ c�.
FOR OFFICE USE ONLY
I I�II�� N{II I�II� Ilill �III� INN IIII) �IN� IIII I�I y?s�
* 1 3961 370'' �-SD
Reque�8��2 Rough-in Inspection Required? ❑Yes C�No Inspection Other Than Rough-in: C�Ready Now ❑wll Call
You must call the inspector when ready! Date Ready:
I certity that I am the �4 LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at
Job Address��, soX�o���t�, � NE c� Fp�DLEY zp c�e 55�132
Section Township Range Fire No. Couny aN�{a
occ�vBlE[)L.ER LONITA 2 9� 4G `, Pho�e
Power Supplier Address
%CEL EN�Y
ElectricaH� t� E� mnan�� ame�,r'� Contractor �ice�ns�e N�m8�3 Master ucense Number
4� 1 ht
Mailing Ad� Contract_o`r,� p�any o�r O� � P�1 in pAUly MN 55114
Authorized ' nature (C�tractor, ompany or Owner Perfortning Installation) Phone
��� 659 ��6-ZQ11
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY