P - 80187J ' REQU�ST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-148 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 - �
(651) 642-0800 TTYIMRS 1-800-627-3529
www.electricity.state.mn.us ' �
Identify the work covered by this request:
❑"NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR XCEL ENERCiY SAVER�S SWITCH
401 to 800 Ampere �
Above S00 Amoere �
CIRCUITS OF LESS THAN 50 VOLTS
ivstem Device or Aooaratus � $.50
3 to 12 Units �$50 Per
� $30 per Hour
� $.31 cer Mile
1
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Und �$F
Additional lnspection Trips (� $20
FOfl INSPECTOF USE ONLY
I hereby certity that I
ROUGN IN
FINAL INSVECTIIXJ
TOTAL FEE
the eledricalinstallation tlescribed herein on the dates sta[eU:
DATE
,�` 2(—
FOR OFFICE USE ONLY
I III(II (IIII Nlil II� �il! IINI II� � Iill I� p�
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1 3961 487 �"` �
Requesl,Aata�,�2 Rough-in Inspection Required? ❑ Yes I,�iNo Inspection Other Than Rough-in: RReady Now ❑ Will Call
ua�zo
You must call the inspector when ready! Date Ready:
I certify that I am the C� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
'-" °��°'^-�� •� ����w tsc�qnu UF ELE(;TRICITY COPY INStRUCTIONS ON BACK OF YELLOW COPY