P - 81848REQUEST FOR ELECTRICAL 1NSPECTION
� � Minnesota Board of Electricity
,' 1-375-408 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 551Q4
(651) 642-0800 TTY/MRS 1-800-627-3529
� www.electricity.state.mn.us
Identify the work covered by this request:
OiiIEW ❑ REMODEL ❑ ADDITION ❑ REPAIR XCEL ENERGY SAVER'S SWITt�i
/
ALARM, CQMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Ap aratus (� $.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI
310 12 Units �$50 Per Unit
b per fixture
Boom � $40
Transiormers over 10 KVA C� $20
Transfortners / Power Supply for Signs / �utline Lighting �$F
ONE & TWO FAMILY DWELLINGS, EACH UNIT
includes the Service and/or Pawer Supply up to 500 Amperes, All
Circuits and Twa Inspection Tdps Each Dwelling Unit �$Bfl
Additional Insoection Trins � $20
TOTAL FEE
total fee is $20)
PoR INSPECTOR USE ONLY
I hereby cerlity �hat 1 inspecletl Ihe electrical instalWtion dascribed herein on the dates sWted:
ROUGHIN DATE
/ �ATE
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� M�THS� ,
FOR OFFICE USE ONLY
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* 1 3754080* �'�'O
Request Date: Rough-in Inspection Required? ❑ Yes ❑ Inspection Other Than Rough-in: eady Now ❑ Will Call
(1�S/1 AJi�'I You must call the inspector when ready� Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: