P - 79774, REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-541 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
` (651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. sta ie. mn. us
Identify the work covered by this request:
�; XCEL ENER43Y SRVER'S SWITC:Fi
❑ IVEW O REMODEL ❑ ADDITION ❑ REPAIR
0 to 400 Ai
401 to 800
0
GENERAL FEES
Above 200 Ampere � $10
A�4RM, COMMUNICATION, REMOTE CONTROL
CIFiCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS (PER UNI�
�I 3 to 12 Units �$50 Per Unit
Retrofit � $25 uer Fixture
Transformers u to 10 KVA �$10
Transfortners over 10 KVA � $20
� Transfortners / Powe� Supply for Signs / Outline Lighting �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$E
Additional Inspection Trips � $20
FOR INSPECTOF USE ONLY
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TOTAL FEE
total fee is $20}
D$25 I hereby certify ihet I inapectetl Me electrical installatbn tlescribetl herein on ihe tlates 8letetl:
(� � � ROUGN IN DATE
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� FOR OFFICE USE ONLY
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Reque Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-in: Ready Now ❑ Will Call
You must call the inspectar when ready! Date Ready
I certify that i am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
ovMr+u ur t�tG i ttiGiTY COPY INSTRUCTIONS ON BACK OF YELLOW COPY