P - 79766REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
Y 1-396-544 � 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104 — _
(651) 642-0800 TTY/MRS 1-800-627-3529
www. e/ectricity, sta te. mn, us
Identify the work covered by this request:
❑ NEW ❑ REMODEL ❑ ADDITION O REPAIR
IALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Ao�aratus �$.50
XCEL ENEROY SAVER'S SWiTCH
Rsn:��i_�,�3r��
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$F
Additional Insoection Trios � $20
MULTIFAMILY DWELLINGS PER UNI'n TOTAL FEE a•�
3 to 12 Units �$50 Per Unit (minimum total fee is $20)
Each Additional Unit �$25 FOp iNSPECTOq USE ONLY
OTHER ADDITIONAL FEES
Li htin ReVOfit �$25 per Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots �$2 I hereby certily that 1 inspecled the electrical inslallatbn described herei� on lhe tlates statetl:
RecrCetional VehiGO Park Sites � AWGH IN DATE
Se arate Bondin Ins ection �$20
S 6Cial In5 'On �$30 er Hour FlNqL INSVECTI , DATE
S ecial Ins ection �$.31 er Mile � 2�+�'3
__THts �NST4i I_aT1oN M4Y�E ORDERED pISCONNECTEgIF NOT COMPLETED_WITHIN_18�IA2N7HS=._ _
� � _FOn OfFICE USE ONLY
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RequeB) �j�/Q'2 Rough-in Inspecdon 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 � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address.��, so���� C�R c�ry ��Y Zip Code �
Section Township Range Fire No. County
Occuo�L..� v'��R Phone
I'�IV 1
Power Sundie[ �
R�L.
Electrical Gq�1�cWr`/.G�slpa[tiv.N��.'� Contractar Lic�pge Alwpqe� Master License Number
��u C Cli 1 n14i �1 WOd,�
�nai�in9 � ���n� � t�ar��g�p tio�N 55114
Authoriz ' nature ( ptract om an or Owner Perfortning Installation) Phone �1 ��,,,�11
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY