P - 79927- REG�UEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-182 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642-0800 Tl'Y/MRS 1-800-627-3529
www. electricity. s ta te, mn. us
Identity the work covered by this request:
O`NEW ❑ REMODEL O ADDITION O REPAIR
IALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units �$50 Per Unit
Each Addi6onal Unit � $25
OTHER ADDITIONAL FEES
Lighting Retrofit � $25 per Fxture
Center Pivot Irrigation Boom � $40
Manufactured Home Pa�C lots � $25
Recreational Vefiide Park Sites (� $5
Separate Bondinp InsDection � $20
XCEL ENERQY SAVER'S SWITGH
Transfortners u to 10 KVA �$10
Trar�sformers over 50 KVA � $20
Transformers / Power Supply for Signs / Outline Lighting �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up ta 50� Amperes, All
Circuits and Two Inspeclion Trips Each Dwelling U�it �$E
Additiona! Insoection Trius � $20
i nereny �enay ma� i �nsPeaea me a��cei
POUGH IN
FINAL INSPECTION
DATE
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FOR OFFICE USE ONLY
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Reque�g�� Rough-in Inspection Required? ❑Yes [�No Inspectlon Other Than Rough-in: �Ready Naw ❑4Y�11 Call
You must call the inspector wt�en readyf Date Ready:
1 certify that I am the I!� LICENSED CQNTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address,j,�t�t, Bo�,RQytg No 1 � City ��Y Zip Code 55�32
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Authorize ' nature (C �trector, ompany.or Owner Perfortning Installatlon) Phone g�1 ii46-2A'f i
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EB-0OOO1A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY