P - 79773REQUEST FOR ELECTRICAL INSPECTION
M;nnesota Board of Electricity
1-396-551 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-08001TY/MRS 1-800-627-3529
www.electricity.state.mn. us
IdentiTy the work covered by this request:
ONEW ❑ REMODEL O ADDITION ❑
to
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Apparatus �$.50
i Boom
Park Lc
C
FEES
XCEL ENEROY SAVER'S SWITGH
Transformers u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transfortners / Power Supply for Siqns ! Oudine Lighting �$:
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circufts and Two Inspection Trips Each Dwelling Unit �$80
Additional Insuection Trips � $20
ROUGHIN
FINAL INSI
TOTAL FEE
total fee is $20)
Mat I inspected the electricel ins[alladon described herein on Me dates ;
DATE
3-z..�°=�
FOR OFFICE USE ONLY
I IIIIII IINI IIIII IIIII IIIII NHI IIIH IIi� ��I �-� -
* 1 396551 2* `2U�'1�
Reque Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-in: Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certify that I am the LK1 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: