P - 79303REQUEST FOR ELECTRICAL INSPECTION
�� 1 1�- 5 6 3� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� {651) 642-0800 TIYIMRS 1-800-627-3529 www.electricity.state.mn.us
� NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XGEL Ef�IERGY SAVFf?'S SW(''�N
Standard (� $1
to 400 Ampere (
�1 to 800 Amper
bove 800 Amper
IITS / FEEDERS
ONE 8 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
CIRCUITS OF LESS THAN 50 VOL7S
to 12 Units @$50 Per Unit (minimum total fee is $20) � $20.50
�ch Additional Unit @ $25 r�rsae�saex+seECr«+usearr
� I hereby cer6y that I inspected the elec0ical installa6on described herein on the dales sUted:
OTHER ADDITIONAL FEES �1 ,. _ � � � � 7 � 6
nhfinn ReMn9t H�l 4 i�. ror Firhiro O��CXJ
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I I�il 11 � il III ii IN II i� � III li lll II �I il ill I I�
177356�0 ���
hiequest Date: Roughtin Inspection Required? ❑ Yes Inspection Other Than Rough-In: ❑ y Now � Will Call
Q��'�0 f(� You must call the inspecta when ready! Date Ready:
I certiTy that ! am ihe C1�lCENSED CONTR,4CTOR ❑ COMPANY ❑ OWNER and hereby request inspecdon of the electricai work at:
IMSTRUCTONB ON BACK OF VELIOW COPY BOARD OF ELECTRIGTV COPY EB-00001M14 8.1. 2002