P - 81854REGlUEST FOR ELECTRICAL INSPECTION
l ❑ Minnesota Board of Electricity
1-375-396 % 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OB00 TTYJMRS 1-800-627-3529
www. electriciry. sta te. mn. us
Identify the work covered by this request:
q�SIEW ❑ REMODEL 0 ADDITION ❑ REPAIR XCEL Eh1ERGY SAVER�..Si S'WITCH
401 to 800 Am ere �$50
Above S00 Am ere � $75
CIRCUITS / FEEDERS
O to 200 Am ere �$5
Above 200 Am re � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
3 to 12 Units �$50 Per
Each Additional Unit � 9
Pivot Irrigation Ba
ctured Home Park
Transfortners up to 10 KVA �$10
ONE 8 TWO FAMILY DWELLIN�S, EACH UNIT
Includes the Service andior Power Supply up to 500 Amperes, All
Ci�cuRs and Two Inspection Trips Each Dwelling Unit �$80
Additional Insoection Tri�s � $20
FOP INSPECTOfi USE CNLY
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TOTAL FEE
I herBGy certity Met I inspecled the eleclrical installation described herein on ihe dates sfated
RWOH IN DATE
FIN/�1 kl$PECTION •� DA1E
, _�__._...._.____.. .. _._. ....._ - - � / t ��
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NO ! MPLETED WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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* 1 3753967* �Q,S�
Request Date: Rough-in Inspection Required? ❑ Yes ❑ Inspection Other Than Rough-fn: eady Now ❑ Wi0 Call
1 1 You must rall the inspector when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical wor9c at: