P - 79922REQUEST FOR ELECTRICAL INSPECTION ,
Minnesota Board of Electricity
' 1-396-188 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642-OS00 TTY/MRS 1-800-627-3529
www. electricity. sta te. mn. us
Identify the work covered by this request:
0'10EW ❑ REMODEL ❑ ADDITION ❑ REPAIR
0 to 400 Ampere � $
401 to 800 Ampere �
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
Center Pivot Irrigation Boom � $4
ManuFadured Home Park Lots �
Recreational Vehicle Park Sites �
XCEL ENEROY SAVER'S SWITGH
Outdoor Liqhtina Standard (� $i
Transfortners u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformers / Power Supply for Signs / OWine Lighting �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Und �$80
Additional Inspectio� Trips � $20
Investi ative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
ROUCaH M
FINqL INSPEC710N
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FOR OFFICE USE ONLY
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Reque��z Rough-in Inspeclion Required? ❑ Yes C�No Inspection Other Than Rough-in: �Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certify that I am the 1�4 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address jStrg�, Bo� �qr$o}�G,ry� � City ��D�Y Tap Code �
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Section Township Range Fire No. County a�KA
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OccuRar�SS � � t� Phone
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Power Su_p I�ier � Address
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Electrica� �t�(p� /�i�1J�g___�,�� Contractor Lica��,e �l�bgr_ Master License Number
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Authoriz nature (Cyptracto ompany or Owner Perfortning Insfallation) Phone �1 6�i-2911
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EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY