P - 79307REQUEST FOR ELECTRICAL INSPECTION
��( 1�- 5 6 7 Minnesota Board of Electricity -
� � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.e[ectricity.state.mn.us
❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - lhe work covered by this request:
X.CEL Et�lERGY SAVER'S SV4{lTCH
to B00
ve 800
0 to 200 Am re $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus (a? $.50
' THIS INSTALLATION MAY BE ORDERE[
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I{�Il II � II III II � II III II�II If �l II I{I II III I I�I
1??356'71
Transformers u to 10 KVA $10
Transformers over 10 KVA @$ 20
Transformer / Power Suppty for Signs I Outline Lightina_ @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � $20.50
THIS NREA Fpt MlSPECtOR USE IX8v
I hereby cerfiry Mat I inspected Me electrical installa6on descnbed herein on the dates stafed:
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2_ 20 --c
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Request Date: Rough�n Inspection Required? ❑ Yes Inspection Other Than Ragh-In: ❑ dy Now ❑ Will Call
��[� f� You must call the i�spedar when ready! Dale Ready:
I certify that I am the C�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he�eby request inspection of the electrical work at:
INSTRUC710NS ON BACK OF YELLOW COPY BOARD OF ELEClRICITY CAPV EB-00007A-14 8.7. 2002