P - 79921REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1-396-189 � 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
Identity the work covered by this request
�NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR xCEL ENEROY SAVER�S SWITCH
GENERAL FEES Outdoor Liahtina Standard �$t
0 to 200 Am ere �$5
Above 200 Ampere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
ADDITIONS TO
MULTIFAMILY DWELLINGS (PEI
3 to 12 Units �$50 Per Un
Fixture
� $4f
�ts � $
�BS �
��
,.1�.
Transfortners u to 10 KVA �$10
Trensfortners over 10 KVA � $20
Transfortners / Power Supply for Signs / Outline Lighting �$!
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Insoecfion Trips � $20
i hereby cerlity M��
ROUGHIN
FINAL INSPECTION
+;,;
TOTAL FEE
d fee is $2�1
herein on tlie dates stated:
DATE
DATE
— �'-`30� e3
FOR OFFICE USE ONLY
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* 1 3 9 6 1 8 9 1'` ��5� ��
Reque Rough-in Inspection Required? ❑ Yes No InspecNon Other Than Rough-in: Ready Now ❑ Will Call
You must call the inspector when readyl Date Ready:
I cedify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address�t, Box.qy9ouis.Np1.� �� City FR�� Zip Code �.�eZ
6tfLU Wl1at111YC31
Section Township Range Fire No. County /�(1�(/1�
occu ac�r tU71Zl FREO J Pnooe
Power Supplier �� Address
KCEL
E���HUIVT ELEG �ZI�C GbRR4RAT10N Contractor Li� N�r�b� Master License Number
uu�
Mailin9 �� I LJKIAI.yh�]�e � Pt1�11Y 1 1"��1.���iiN 55114
Authorized nature (Contractoi� C�ompeny or Owner Performing Installation� Phone
651 �-2t111
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS OIJ BACK OF YELLOW COPY