P - 78085REQUEST FOR ELECTRICAL INSPECTION
1� J��- 6 71 �2 Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, (651) 642-08Q0 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
� NEW 0 REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy 'rf necessary - Ne work covered by this request:
0 to 400 Am ere E25
401 to 800 Am re $
' Above 800 Am eie a75
C CUITS I FEEDERS
0 200 Ampere (a? $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
2 Units @ $50 Per Unit
Additional Unit @ $25
OTHER ADDITIO
ng Retrofit Q$.25 per Fixture
:r Pivot Irrigation Boom @ $4(
factured Home Park Lots an. $
:ational Vehicle Paric Sites �
Transformers u to 10 KVA $10
Transfortners over 10 KVA a 20
Transfortner / Power Su I for Si ns / Outline Li htin $5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senice andlor Power Supply up to 500 Amperes, All
NG Circuits and Two Inspec6on Trips Each Dwelling Unit @$80
Additional Ins tion Tri s $20
Investioalive Fee
( TOTAL FE j I $ 5. 5 � I
minimum total fee is $20
iH15 MEA FOR INSPECiOR USE ONY
I hereby cerlify that I inSpeGed the ekctrical install�on described heiein on the dales sGted:
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Request Date: Rough-in Inspection Required? Yes ❑ No Inspeclion Other Than Rough-In: ❑Ready Now ❑ Will Call
You must call tF�e inspecta wh ready! Dale Ready:
I certify that I am the ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tl�e elechical work at::
Job Site Address (Street, Box, or Route No.) City Zip Code
�� 1221 NORTON AVF FRTiIT.FV
P M J HOMES
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XCEL ENF.RrY
63
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AVE N BROOKLYN PARK MN
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M8St8f GectriGan of
Ucense Number
I 763_537-0807
BOARD OF ELECTRICITV COPV EB-OOD01M74 8.1. 2002