P - 79322, ❑ REQUEST FOR ELECTRICAL INSPECTION
� �'] � � � [ p p � Minnesota Soard of Electricity -
1 J O O 1821 University Avenue Suite 5-128, Sai�t Paul, Minnesota 55104
(651) 842-OS00 TfY/MRS 1-800-627-3529 www.etectricity.state.mn.ur
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of lhe white copy if necessary - the work covered by this request:
7{GEL ENERGY SAVER'S �WITCH
/ POWER SUPPLIES
401 to B00 Am re $50 Transformers u to 10 KVA $10
Above B00 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transformer I Power Su I for Si ns I Outline Li htin $5
0 to 200 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes ihe Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and iwo Inspecfion Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri s $20
Each S stem Device or aratus $.50 InvesG ative Fee
ADDITIONS TO THE GENERAL FEES Reins tion Fee $20
MULTIFAMILY DWELLINGS PER UNIT TOTAL FEE
3 to 12 Units @$50 Per Unit (minimum total fee is $20) $20,50
E2Ch Additional Unit @$25 �ws �aFn Fon nucECTon usE aar
I hereby certiy that I inspected the electrical instaNa6on described herein on the dates stated:
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Request Date: Rough-in InspecGon Required? ❑ Yes I�spection Other Than Rough-In: y Novr � WU� Cal�
Q�QfQ� You must call the inspecla when ready! Date Reedy:
I certify that I am the Cp�ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the efectrical work aY.:
INBTRUCTONS ON BACK OF VELLOW GOPY BOARD OF ELECTRICIT' COPV E9•WOOlM19 e.i. ew[