P - 81973r REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
'' 1-377-47G 5 1821 Universiry Avenue Suite S-t28, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. e%ctricity. state.mn. us
Identity the work covered by this request:
Q�VEW ❑ REMODEL ❑ ADDITION ❑ REPAIR XCEL ENERGY SAVER�� SWITCH
800 Ampere �
800 Amoere �
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUiTS. CIRCUfTS OF LESS THAN 50 VOLTS
Each System Device or aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAM�LY DWELLINGS (PER UNIT)
Each
Home
� $� D8f iiOUf
.... _,. _�......,.,..
��
x )�,
�.,
Transformers u to 10 KVA �$10
Transformers over 70 KVA � $20
� Transiortners / Power Supply for Signs / Outline Lighting �$5
ONE 8 TWO FAMILY OWEL�INGS, EAGH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$60
Additional Inspection Trips � $20
Investi ative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
FOP INSPECTOfl IISE ONLY
1 hereby carlify Mat I inspecled ihe
ROUGH IN
0
tlescribetl herein on Me datea sletetl: I
OATE
� T6 -d/
� FOR OFFlCE USE ONLY
� f����l f�N� II��{ ��I�� III{{ IN�� H�II �� �I� •
* 1 3 7 7 4 7 6 5* "���`s0'� ��`S�
Request Date: Rough-in Inspection Required? ❑ Yes ❑ Inspection Other Than Rough-in: eady Now ❑ Wtll CaN
Q�%��� 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: