P - 80471REQUEST FOR ELECTRfCAL INSPECTION
, Minnesota Board of Electricity
1-381-455 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
IIdentiTy the work covered by `:�is request:
QNEW 0 REMODEL U ADD{TION ❑
o to aoo
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A aratus �$.50
ADDI710NS TO THE GENERAL FEES
TIFAMILY DWELLINGS (PER
3 to 12 Units �$50 Per Unit
Retrofit � $25 per Fixture
'ivot Irriqation Boom � $4a
XCEL ENERGY SAVER'S SWITCH
Transfortners u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformers I Power Supply tor Signs / Outline Lighting �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
{�ludes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unii �$E
Additional Ir�spection Trips � $20
TOTAL
FOP INSPECTOF USE ONLY
� nereey cerMy tnat � Inspectea me electrical ins�a�lenon aescribea nerein on me aa�es starea:
ROUGMIN DA7E
FINALINSPECTION DATE
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FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ o Inspection Other Than Rough-in: eady Now ❑ Will Call
�$%�8ro1 You must call the inspector when ready! Date Ready:
I certity that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: