P - 81978:- -
REQUEST FOR ELECTRICAL INSPECTION
, Minnesota Board of Electricity
1-377-481 5 te21 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn. us
Identify the work covered by this request:
�FIEW ❑ REMODEL ❑ ADDITION ❑ REPAIR XCEL ENERGY SAVER�S SWITGH
, GENERAL FEES Outdoor Liqhtina Standard �$1
401 to 800
�
IAL4RM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRGUITS. CIRCUITS OF LESS THAN 50 VOLTS
TIFAMILY DWELLINGS (PER
3 to 12 Units �$50 Per Unit
,,��`�
i�;
..,,,.. .........:.:. r.: �...:....:.:
Transiormers u to 10 KVA �$10
Transfortners over 10 KVA � $20
Transfortners ( Power Supply for Signs I Outline Lighting �$!
ONE 8 TWO FAMILY DWE�LINGS, EACH UNIT
Includes the Service antUor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips � $20
f-0P INSPECTOP USE ONLY
I hereby cerlity th
RWGH IN
FINqL INSPEC710N
TOTAL
d fee is
on Me dems steted:
�DATE /
�� � �l
IFOR OFflCE USE ONLY
i iii�i �iii Hii� iiiii ii�ii iiiii ��ii i�i a�"� �
" 1 377481 5* �'���
Request Date: Rough-in Inspection Requiredl ❑ Yes ❑ Inspection Other Than Rough-in: eady Now ❑�II Call
Q�/Q� You must call the inspector when readyl Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecGon of the electrical work at: