P - 80178� REQUEST FOR ELECTRICAL INSPECTION
, Minnesota Board of Electricity '
1-396-157 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 ` �
(651) 642-0800 TTY/MRS 1-800-627-3529
www, electricity. sta te. mn. us
Identiry the work covered by this request:
OT7EW ❑ REMODEL ❑ ADDITION ❑ REPAtR XCEL ENEROY SAVER�S SW�TCH
GENERAL FEES Outdoor Li htin Standard (� $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am ere �$75 Transfortners over t0 KVA �$20
CIRCUITS / FEEDERS Transfortners / Power Su I for Si ns I Outline Li htln �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service and/or Power Supply up io 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unft �$80
CIFiCUITS. CIRCUtTS OF LESS THAN 50 VOLTS Additional Inspection Trips (� $20
Each S stem Device or A paratus �$.50 Inves6 ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20
12
TOTAL FEE
total fee is $20)
FOF
Park Lots �$25 I hereby certify ihat I inspected the electricel instelletbn dascriDed herein on the Cetes sletetl:
Park SfteS � $5 ROUGMIN onre
spection � $20
C'U1 ncr Llniv FIWILINSPECTION A'�� DATE
� $.31 per Mile
! ��./ I
� FOR OFFICE USE ONLY
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* 1 3961 578* �150 ��S
Reque���'Z Rough-in Inspection Required? ❑ Yes C�No Inspection Other Than Rough-in: �Ready Now ❑�If Call
You must call the inspector when ready! Date Ready:
I certiiy that I am the L� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address�, so���te t�.�E C�ry ,. FRIDLEY 2ip Code �3
Section Township Ran�e Fire No. County q�q
2
°r�°�IRISTIANSC�N DANIEL L • ' Pnone
Power SapQlier �v Address
�."CL
Electrica�t tty /�,�q�p�iy���QN Contractor Lic§�ge �y�qp�i Master License Number
t 4� I t'(I �s�°1 LA7Ct3�i
Mailing 9� 1�9c�i�ny� v�r� Pbqrto�g� I tio�N �114
A
Authorize ' nature (�racio ampany or Owner Perfortning Installationj Phone
651 6�ti-2911
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY