P - 79747REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
' 1-396-563 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www.electricity.state.mn. us
Identify the work covered by this request:
l] NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR XCEL EMERQY SAVER'S SWITCH
401 to 800 Am
Above 800 Am
CIRCUITS / FEEDEf
0 to 200 Am er
Above 200 Am
ALARM, COMMUNI(
CIRCUITS. CIRCUIT
Each S stem D
ADI
MULTIFAMILY DWE
3 to 12 Units �
�
�/BhIC�B
W, REMOTE CONTROL, SIGNALING
LESS THAN 50 VOLTS
or Apparatus � $.50
NS TO THE GENERAL FEES
iS PER UNI
Per Unit
--_='_--'� �MAYBEDR
I I II III Illll II Iil hl� II I
Il IIIII IIIii IIIII IIII I�l
* 1 3 9 6 5 6 3 7*
Transformers u to 10 KVA �$10
Transfortners overl0 KVA � $20
Transfortners I Power Supply for Signs I Outline Lighting �$;
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Inc(udes the Service and/or Power Supply up to 500 Amperes, Alt
Circuits and Two Inspection Trips Each Dwalling Unit �$80
Additional Inspection Trips � $20
� Reinspection Fee � $2C
FIXi INSPECTpi USE ONLV
I hereby cerOfy Mat I inspected Me
ROUGH IN
FINHL INSPEC710N l�Z
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� .,�,-�. �
� ��3
TOTAL FEE
total fee is $20)
FOR OFFICE USE ONLY
�# �s�
DATE
D�AT—E+
: \ �
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I,--• -�--•..� y��-�n mspecnon „equiretl? LJ Yes I�No I Inspection Other Than Rough-in: Ready Now Q Will Cal!
You must call the inspector when readyl Date Ready
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (l 1 O� so�C3�i� �Y NE °ih" FRfIX.EY zp code
�:
Section Township � Range Fire No. County
�Y.
o�u�A� Ap�Q KRISTIE S ano�e
Power $�� � Address
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F1VIVi ECECTRIC'�j�� I�ontractor�ic�o�e�
Mailing AddrASS-0Ccpvar2���e �,py,p�! q����,_„__o�N �7��4
C�A71tKK1�UKiALKC!/W b '���'``,�'
4uthoriz ' nature ( ptract om an or Owner PeAOrtning Installation)
B'00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY
Master License Number
a�� s�-2s�4 �
INSTRUCTIONS ON BACK OF YELLOW COPY