P - 79226� REQUEST FOR ELECTRICAL INSPECTION
�� 7 6 8- 5 5 9� Minnesota Board of Electricity - _
1621 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' (651) 642-0800 TTY/MRS 1-800-627-3529 www,electriciry.state.mn.us
NEW 0 REMODEL ❑ ADDITION D REPAIR Describe -usin the back of the white copy if necessary - the work covered by this request:
iCCEL ENERGY SAVE�'S SWiTCH
GENERAL FEES Outdoor Liah6na Standard a(2 $1
ONE & TWO FAMIl.Y DWElLIMGS, EAGH UNIi
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips E2ch Dwelling Unit �? $80
CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERAL fEES
s to 12 Units �$50 Per Unit (minimum total fee is $20) � �0.54
E2Ch Additi01121 U�it @$25 Tws na� Foa irurECroa use aav
, �T I hereby certi(y thffi I inspected the elec6ical instaNation dexribed hereio on Ihe dates sG�d:
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Request Date: I Rough-in InspeUion Required? U Yes LJ"hto Inspedion Other Than Rough-In: LJReady Now U WYI Call
����� You must call the inspactor when ready! pate Ready.
I certiiy that I am the �ICENSED CONTRACTOR ❑CCNvIPANY � OWNER and hereby request inspection of the electrical work at:
INSTRUCT10N3 ON BACN OF YELLOW GOPY 80ARD OF ELECl1iICT' COPY EB-00001M71 8.1. 2002