P - 79342❑ REQUEST FOR ELECTRICAL INSPECTION �
� ^ � � � - 610 .,7 Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL Q ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XGEL EP1E�?GY SAVER'S SWITCH
GENERAL FEES Outdoor Li hGn Standard $1
SERVICES / POWER SUPPLIES Traffic SiQnal Standard (�a $5
401 to 800
Above 800
:UITS / FEE
CQMMUNICATION, REMOTE CONTROL, SIGNALfNG
S, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @ S56 Per Unit
Each Additional Unit @ $25
i �� � � II � II ��� �I IlI ��lll if �l ���i l� � ��
L77�b1�L�9
ONE & TWO FAMILY DWELLINGS, EACH UNIT
I�ludes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins tion Tn s $20
Investi ative Fee
Reins tion Fee $20
TOTAL FEE
(minimum total fee is $20) $30.�0
TNiS MEA FIXt iNSPEC�Oft USE OILLY
I hereby ceAify Mat 1 inspected the ekctrical installa9on descnbed haein on ttie deRes stated:
ftW('a4IN MTE
FINMNSPECi10N WTE
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EXPIREDII�8ND01JED MTE
:CTED IF NOT COMPLETED WITHIN 12 MONTHS
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Request Date: Rough-in Inspection Required? ❑ Yes ❑�Rlo I�spection Other Than Rough-In: Ok�ady NrnN O V1hll Call
[I��%� You must call the inspector when ready! Date Ready:
I certify that I am the CbCICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of U�e elecMrical work at:
iNSrrtucnoNS a+ awac oF rEUOw corr BOARD � ELEClTtICITV COPV EB-0OOO7M74 e.�. 2002