P - 79780.,- - - -
REQUEST FOR ELECTRICAL INSPECTION
� ❑ Minnesota Board of Electricity
1-396-552 �} 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www. electricity. sta te. mn. us
Identify the work covered by this request:
x
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGt
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus t� $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNIT
3 to 12 Units (� S50 Per Unit
Recreational
lJ
Mile
XCEL ENEROY SAYER'S SWITCH
Treific Si nal Standard � $5
Su lemental Fee � $20
Transfortners u to 10 KVA �$10
Transfortners overl0 KVA � $20
Transfortners / Power Su I for Si ns / OuUine Li htin (�
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Ir�cludes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$f
Additional Inspection Trips � $20
Investiaative Fee
FOR INSPECTqi USE ONLV
i nereny ceruty ma� i �nsPeaed me eiearicsi
ROUGH IN
FINAL INSPECTION . �+ i
TOTAL FEE
DATE
DATE /�
�ZS'O 7
FOR OFFICE USE ONLY
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3 9 6 5 5 2 0
Reque Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-in: Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certi(y that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (�t, Bo� � NE Ciry FRtDLEY Zip Code �2
Section Township Range t. Counry
Occupaqt��.�E �ATM'� � Phone
CC�
Power Supnlie[ �� Address
1�EL
Electrical GoQiFpc}p� /,CyWp�y.1V pa yqR�A�� Contredor Licyp�e� Master License Number
11VIV 1 CLC4i I ri14i w Vr�1
Mailing ��i`C�ii�'"�� �'�i�ii��N 55114
Authoriz ' nature (�tractg� om a or Owner Perfortning Installation) Phone �f1 Q�'�-�� 1
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EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY