P - 80472� REQUEST FOR ELECTRICAL INSPECTION
` Minnesota Board of Electricity
' 1-381-454 � 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:
LIREW ❑ REMODEL ❑ ADDITION ❑ REPAIR
� 800 Ampere �
/FEEDERS
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus �$.50
TIFAMILY DWELLINGS (PER
3 to 12 Units �$50 Per Unit
Each Additional Unit (� $25
XGEL ENERGY SAVER'S �WITGH
Supplemental Fee �
Transfortners up ta 1
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$f
Additional Insoection Trios � $20
TOTAL FEE
USE ONLY
I hereby certify thet I inspected the electrical installation descriDed herein
ROUGH IN
FIW1L INSPECTION _ /1
DATE
DATE
�//i O
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-in: Ready Now ❑ Will Call
d$�8�� You must call the inspector when ready! Date Ready:
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at;