P - 79212. REQUEST FOR ELECTRICAL INSPECTION
�"" � V�- 5 3 4� Minnesota Board of Electricity - _
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' (651) 642-0800 TiY1MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ ADDITION ❑ REPAIR Describe -usin the back of the white copy if necessary - the work covered by this request:
XGEL ENERGY SAVE4�'S SWiTCH
0 to 400
0 to 200 Am ere $5
Above 200 Ampere _$10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @
Each Additional
Center Pivot
� � � � Il � II I� (I (II {I Iil Il �I II I{{ {i �I I fll�
�,7685348
Traffic
Fee @ $2U
uptolOKVA@$10
over 10 KVA (� S 20
ONE 8 TWO fAMILY DWELLINGS, EAGi UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit � E80
(minimum total fee is $20) � 20,fi0
THIS MFq FOR WSPECiIXiVSE IXYY
I hereby cerfiry ihat I inspected the electrical insGlla6on described herein on the dafes stated:
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nequesc uate: Rough-in Inspection Required? LJ Yes LI Tfo I�speclion Other Than RougMn: ❑ y Nav � Will CaIV
07��� You must call tFie inspector when readyl Dale Ready:
l certi(y that I am the ❑�SICENSED CONTRACTOR �COMPANY ❑ OWNER and hereby request inspection of the electricai work at:
INS7RUCTON8 ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY E&0OOO7M14 8.1. 2002