P - 79919. � REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
�-39F)-� 41 � 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity, state. mn. us
IdeMify ihe work covered by this request:
0'17EW ❑ REMODEL ❑ ADDITION ❑ REPAIR XCEL EhtEROY SAVER�S SWITCH
to
�
AIARM, COMMUNICATION, REMOTE CONTR�L, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per Fi�ure
Center Pivot Irrigation Boom � $40
Manufactured Home Park Lots � $25
Recreallonal Vehicle PaAc Sites � $5 �
SeDarafe Bondinq Inspection � $20
;.,� �.
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Transformers overl0 KVA � $20
Transfortners / Power Supply for Signs / Outline Lighting �$;
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
CircuRs and Two Inspection Trips Each Dwelling Unit �$80
Additional Insoection Trios � $20
TOTAL FEE
total fee is $20)
I hereby cerliy that I inspected the electricel installation described herein on the tletes sfated:
ROUGHIN �ATE
FINAL INSPECTION /� OATE
Special Inspection � $.31 er Mile
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FOR OFFICE USE ONLY
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Reque���2 Rough-in Inspecdo� Required? ❑Yes [�No Inspection Other Than Rough-in: �Ready Now L]wll 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 electricaf worfc at:
EB-00001A-13 7/1/2000 BOARD OF ELECTFICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY