P - 81976REQUEST FOR ELECTRICAL INSPE�TION
Minnesota Board of Electricity
' 1-377-479 � 1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104
(651) 642-0800 TTY(MRS 1-800-627-3529
www. e%ctricrty. sta te. mn. us
Identify the wo�C covered by this request:
OXJEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERALFEES
SERVICES I POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Ampere � $50
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGP
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Ap aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
� $.31 oer Mile
IiIIII Ilill iilli il�l {NII il�l Illl�ifi Iill INI
* 1 3 7 7 4 7 9 9''
XCEL Eh1ERGY �AVER'S �WITGH
Transformers over 10 KVA � $20
Transformers / Power Supply for Signs / Outline Lighting �
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and(or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling UnR �$f
Additional Insnection Trios � $20
Fee �
FOF INSPECTOR USE ONLY
I hereby certily Mat � inspecled Me electncal
ROUGH IN
FINALINSPECTIpN l� l
FOR OFFlCE USE ONLY
Q��,�—� �a!so
TOTAL FEE
totalfee is $20)
DATE
�l `
I Request Date: I Rough-in inspection Required? ❑ Yes ❑ NL I Inspection Other Than Rough-in: [JReady Now G Will C811 I
(yg%�%�i � You must call the inspector when ready! 1 Date Ready:
I certify that I am the rJ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection oi the electrica� work at: