P - 79778REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
� 1-396-542 � 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:
X XCEL EhlEROY SAVER'S SWITCN
❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or Ap aratus �$.50
ADDITIONS TO THF GENERAL FEES
MULTtFAMILY DWELLINGS (PER UNIT)
3 to 12 Units �$50 Per Unit
$25
Park
Transfortners u to 10 KVA �$10
Transfortners over 10 KVA � $20
� Transformers ! Power Supply for Signs / Outline Lighting �$:
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips (� $20
Investigative Fee
FOflINSPEGTOP
I hereby ceRify that I
RW�H IN
FINAL INSPECTION
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TOTAL FEE
total fee is $20)
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FOR OFFICE USE ONLY
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DATE
DATE
2 5 ��3
I certify that I am the [� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Addressi&Awt, go;, �p�,�„� � �
I'U.7� GI'11\Ciil �"�' FRIDLEY zP coaa .
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Section Townsbip Ran e
9 Fire No. County
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"'""�tRREIT MICHELE M
Power S�uooli�c �V Address
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�T�� I Contrector Li� /y��� Master License Number
W40J
P� ���;°A�N 55114
Owner Perfortnin In t II '
��� �� g s a etion) Phone
�if 6�f-Z91i
:8-00001A-13 7H/20pp BOARD OF ELECTRICITY COPY
INSTRUCTIONS ON BACK OF YELLOW COPY