P - 79306REQUEST FOR ELECTRICAL INSPECTION
�����- 5 6 6� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55704
(651) 642-0800 TTY/MRS 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:
XCE� ENERGY SAVER'S SWfTCH
GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Sianal Standard C� S5
� Transformer I Power Supply for Signs I Outline LighGng @$5
ONE & 7WQ 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, CIRCUITS OF LESS THAN 50 VOLTS
fiFAMILY DWELLINGS (PER UNIT) TOTAL FEE �
3 to 12 Uni� @$50 Per Unit (minimum total fee is $20) $2�.5�
EaCh AddiG0�21 Unit @$25 *Nis a�n voa i�crors usE anr
- I hereby certify that I inspected the electrical insfall�on described herein on the dales sf�ed:
OTHER ADDITIONAL FEES ,�.CG ��( _ O("j � A
Liahlina Rehofit O 3.25 oer Fixlure 7
I iRN II {� II III {{ iH I{ IN � III II �I II �I II III I�II
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Request Dffie: Rough-in Inspeclion Required? ❑ Yes Inspedion Other Than Rough-In: ❑ y Now � WNI Call
� jf'10f� You must cail Me inspector when ready! Date Ready:
I certi(y lhat I am the C�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec6on of tlie electrical work at::
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