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P - 79211� REQUEST FOR ELECTRICAL INSPECTION �� 7 6 8-� 3 3� Minnesota Board of Electricity - 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � (651) 642- 0 80 0 T f Y/ M R S 1- 8 0 0- 6 2 7- 3 5 2 9 www.e lec trici ty.s ta t e. m n. u s NEW O REMODEL ❑ ADDITION ❑ REPAIR Describe -usin the back of the white copy if necessary - the work covered by this request: }CGEL ENERGY SAVE�'S SWfTCH POWER ALARM, COMMUNICATION, REMOTE CONTROL, SIG CIRCUITS, CIRCUITS OF LESS THAN 5D VOLTS Each System Device or Apparatus @$.50 ADDITIONS TO THE GENERAL FEES 3 to 12 Units @ Each Additional Liahtino Rehofit Traffic Fee up to 1f over 10 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 Additional Inspection Trips @ $20 � Invesliaative Fee TOTAL FEE I (minimum total fee is $20) ��•`�0 ��sa�nFOa�c.ca�aar I hereby certify that I inspecled the electrical installa6on described haein on the dates staBed: �n�� ��I ���{� Il {il ll 1� II �I I{ �1 II l{I I l� I�l �q�g� � ; O �7685330 � ���� a,��i� � Request Date: � Rough-in Inspection Requiretl? ❑ Yes O Inspecfion Other Than Ragh-1�: ❑ dy Nnw � Will Call ����� You must call the inspector when ready! Date Ready. I certi(y that I am the �CICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of tfie electrical work a�: INS7RUC710NS ON BACK OF YELLOW COPY BOARD OF ELECTRICITV CAPY E&OOOUTA-11 &1.2002