P - 80180w, i
1-396-155
REQUEST FOR ELECTRICAL INSPECTION
�Minnesota Board of Electricity
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:
❑TEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
401 to 800 Ampere �
Above 800 Ampere �
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A paratus �$.50
ADDITIONS TO THF GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI
3 to 12 Units ��50 Per Unk
Fixture
XCEL EI�ER�Y SAVER'S SWITC:H
Transformers over 10 KVA � $20
Transformers / Power Supply for Signs / Outline Lighting �
ONE & 1W0 FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Suppty up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$f
Additional inspection Trips � $20
ROUGH IN
FlW1L INSi
FEE
I insoected the electrfcal instelletion described herein on
DAtE
DATE
�� ��
FOR OFFICE USE ONLY
IIIIIIIIilllil�llllllllllllllll�l��l(I�I�I ��
* 1 3961 552* � �.C�
Requs���2 Rough-in Inspection Required? ❑Yes C�No Inspection Other Than Rough•in: C�Ready Now ❑wll Call
You must cell the inspedor when ready! Date Ready:
I certity that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
.� add�e� � 134 � LQIdOF'EI.�QW ST N ��� FRIC�LEY z�p coaa 55�{3
Section Township re No. Counry A�a
Occu �'�� �+� � Phone .
Power Supplier Address
x� �r
E����HU �NT EIECPR�Gam�e �,r,'� Contractor LiceCns�e N�b8e3 Master License Number
Mailing q{iQrgs� ���gnq�ny�r Oy�ner,PgrfoRnjpg��tallation�N 55114
��00 G.Mi1P1L fiURU SP111Y 1 Al1L,
Authorize ' nature (�ractor, ompany or Owner Perfortning Installation) Phone
651 6�2911
EB-00001A-13 7/1/2000 BOARD OF ELECTRICIN COPY INSTRUCTIONS ON BACK OF YELLOW COPY