P - 80177- REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
,• 1-396-158 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TTY/MRS t-800-627-3529
www.electricity.state.mn. us '
Identify the work covered by this request:
U NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR XCEL ENEROY SAVER�S SW ITCH
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 Transfortners u to 10 KVA �$10
Above 800 Am ere �$75 Trenstormers over 10 KVA �$20
CIRCUITS / FEEDERS Transfortners I Power Su I for Si ns / Outline Li hfin �$5
0 to 200 Am ere �$5 ONE R NJO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS Additional Inspection Trips �$20
Each S stem Device or Ap aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20
Y
FEES
Pivot
TOTAL FEE
total fee is $201
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I hereby cenity that I inspecled Me eledrical installetion describetl herein on the detes steted:
ROUGHIN D/TE
FIfUL INSPEC710N � DATE
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FOR OFFICE USE ONLY
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Reque�.2 Rough-in Inspection Required? ❑Yes C�No Inspection Other Than Rough•in: �Ready Now ❑�II Call
You must call the inspector when readyl Date Ready:
I certify that I am the �9 LICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the electrical work at:
Job Address��, Bo�, p�[ipy►g,yQ.L� City FR�� Zip Code ��
Mtfis f tFi KU
SecHon Township Range Fire No. County A�KA
Occup�� _ _,_s ��A� � t � Phone
tl13C)(.7Y�
Power Su iier Address
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ElectricaJ �qQt�(p�,/�gq��1�T+� Contractor Lic�;e Zlyry�� Master License Number
IylJi�t 1 tL.tl�! MIC� U�°I L)DCt}
Mailingy��r.s�,s,(�ppj�or f:nmpeny���e;p�r(pRryppJp� I tioQ),N �J��4
'L,iW 1 tFilil l tJFi1P1L FZCJAU AIn11 f.�• M
Authorize ' nature (�ractor, ompany or Owner Performing Installation) Phone
�i1 646-2911
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY lNSTRUCTIONS ON BACK OF VELLOW COPY