P - 79769' REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-535 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www.electricity.state.mn. us
Identify the work covered by this request:
x
O NEW 0 REMODEL O ADDITION ❑ REPAIR
to S00
Above 200 Ampere � $10 �
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNITI
�ditional Unit � $25
OTHER ADDITIONAL FEES
i Retrofit � $25 per FMure
Pivot Irri ation Boom � $40
ctured Home Park Lots �$25 �!
ional Vehicle Park Sites � $5
e Bonding Inspection � $20
XCEL ENEROY SAVEFrS SWITCH
Transfortners u to 10 KVA �$10
Transfortners overl0 KVA � $20
Trensfortners / Power Supply for Signs / Outline lighting �
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service and/ar Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$f
Add'Rional Inspection Trips � $20
Investioative Fee
TOTAL FEE I
(minimum total fee is $20)
fON INSPECTOfi USE ONLV
I hereby certity that I inspected Me electncal instellation described herein on the dates t
RWGH IN �ATE
FINAL INSPECTION DATE
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Requesj Q�Q� Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-in: Ready Now ❑�II Call
You must call the inspector when ready! Date Ready:
I certi(y that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY