P - 80190� REQUEST FOR ELECTRICAL INSPECTION
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• Minnesota Board of Electricity
1-396-145 � 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:
O`NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR XCEL ENERQY SAVER�S SWITCH
�
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 UniTS �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIO
�hting Retrofit � $25 per Fi�cture
Cerder Pivot Irrigation Boom � $4C
Su lemental Fee � $20
Transfortnars u to 10 KVA �$10
Transformers over 10 KVA � $20
Trensfortners / Power Su I for Si ns / Outline Li htin �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$SO
Additional Inspection Trips � $20
Investi ative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
FOF INSPECTOR USE ONLY
RWGH IN
FINAL INSPECTION
DATE
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FOR OFFICE USE ONLY
I IIIIII IIIII IIIII IIIII IIIII IIIII III� �(�I �
* 1 3961 453* '�`��� ���5�
Reque���/02 Rough-in Inspection Required? ❑ Yes [�Jo Inspection Other Than Rough-in: Ready Now Q Will Call
You must call the inspector when ready! Date Ready:
I certity that I am the L� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (SSwci, Ba���ST NE ��� FRtDLEY ZiP Code �
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Section Township Range Fire No. County /j /�
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Power Sap�lier �V Ad ss
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Electrical �ot]t[actqr /�o��S1��Tl� Contractor Licg��,e �y�9pgr3 Master License Number
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n�ai�ing Addrfl� ff�plcect�,Lnrn�ny.or.Dwuer1P�rfpr�p�i�t � tio�N 55114
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Authoriz ' nature (�ractor ompany or Owner Performing Installation) Phone
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9-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTiONS ON BACK OF YELLOW COPY