P - 79311❑ REQUEST FOR ELECTRICAL INSPECTION -
�� 7 7 3- 5 71 3 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
fl NEW 0 REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
}�CEL ENERGY SAVER'S SV1+iTGi-i
GENERAL FEES Outdoor Liqhtinq Standard aC2 $1
0 to 400 Am re $25 Su lemental Fee $20
401 to 8�0 Am re $50 Transfortners u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
;UITS I FEEDERS Transfortner I Power Su I for Si ns I Oulline Li hGn $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up l0 500 Amperes, All
tM. COMMUNICATION. REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS QF LESS THAN 5� VO�TS
Each Svstem Device or Aooaralus C� 5.50
Hour
Mile
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177357a,3
Fee
TOTALFEE
(minimum total fee is $20) $20.50
iH15 ARFh FOR 1115PECTOR USE 0llY
I hereby cerUry mat I inspecled the ek�ctrical instaNa6on described herein on the daBes sta�d:
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Request Date: Rough-in Inspection Required? ❑ Yes ❑'Wo InspeGion Other Than Rough-In: ❑t�ady Now LJ Wdl Call
���a� Vou must call the inspector when ready! Date Ready.
I ceRify that I am the Oj�ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of tt�e electrical work at:
INSTRUCTONS ON BACK OF YELLOW COPY BOARD OF ELECTRIGTV COPY EB-0OOD1M14 .8.1. 2002