P - 79917� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity ° �
1-396-143 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www. electricity. state.mn. us
Identiy the work covered 6y this request:
U'19EW ❑ REMODEL ❑ ADDITION ❑ REPAIR
C
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A aratus �$.50
ADDITIONS TO THF GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 UnNs �$50 Per Unit
� $25 per Flxture
�ation Boom � $40
xne Pa�C Lots � $
XCEL ENERCiY SAVER'S SWITCH
i ransrortners over i u KvA e y�u
Transiortners 1 Power Suppty tor Signs / Outline Lighting �$5
ONE & TWO FAMILY DWELLIN�S, EACH UNIT
Includes the Service and/or Power Supplyup to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling UnR �$80
Additional Inspection Trips � $20
Investi ative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
FOF INSPECTOR USE ONLY
I nereby certify that I inspected Me electrirsl installation descnbed nerein on the detes stated
ROUGHIN DATE
FINAL INSPECTION DATE
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FOR OFFlCE USE ONLY i
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Reque��'Z Rough-in Inspection Required? ❑ Yes [�No Inspection Other Than Rough-in: I�Reedy Now ❑ Will Call
You must call the inspectw when readyl Date Ready:
I certity that I am the I� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job AddresslStrep.t, Box, p,gnute.yp L VE� r C Ciry �� Zp Code �21
JU8/ FiUC3hitb A
Section Township Range Fire No. Counry A�(A
Occuq$r�, _K ��„r phone
hiC7Lt
Power Supplier Address
XC�� ENERGY
E���HUWT ELECr 1 K�Gam��,r'� Contractor Lice� Nu�mbBe� Master License Number
Mailin9�r �qf,��y�o�r'P��ir�g���o�N 5.5114
Authoriz ' nature (C�pirector, ompany or Owner Performing Installation) Phone
$' 651 8�6-2911
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY