P - 81853REQUEST FOR ELECTRICAL INSPECTION
r' Minnesota Board ot Electricity
1-375-413 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
� 1 (651) 642-0800 TfY/MRS 1-800-627-3529
www.electricity.state.mn. us
Identity the work covered by this request:
❑MIEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
to
o to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
to 12 Units �
Ughting Retrofit � $25 per Fixture
Center Pivot Irtiaation Boom � $�W
XCEL ENERGY SAYER'S �WITCH
Transfortners u to 10 KVA �$10
Transfortners overl0 KVA � $20
Transformers / Power Supply for Signs / OuNine LightinQ (�
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$t
Additional Insoection Trios � $20
ROUGH IN
FINAL INSI
TOTAL FEE
total fee is $20)
herein on ihe dates steted:
�" °� �
FOR OFFlCE USE ONLY
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Request Date; Rough-in Inspection Required? ❑ Yes ❑ Inspection Other Than Rough-in: eady Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: