P - 79248REQUEST FOR ELECTRICAL INSPECTION "
�`( 1 O- 6 4 3� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -usin the back of the white copy if necessary - the work covered by this request:
KCEL ENERGY SAVEI?'S SWITCFi
GENERAL FEES Outdoor Liqh6nq Standard (�a. $1
SERVICES / POWER
0 to 400 Amcere
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus na $.50
Retrofit
1I�I II� ��IIi IIIII I�III ��� IIIII I�II� �� I�
177Q�+f33
Standard
ONE & TWO FAMlLY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Dwelfing Unit @$80
(minimum total fee is $20) � 2D.50
THIS ARfA FOR INSPECTOR USE pSY
I hereby certiry that I inspected the elecbical inst�lation described herein on the daAes sta4d:
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neques[ uate: Rough-in Inspection Required? ❑ Yes ❑ Nc � Inspection Other Than Rough-In: ❑ dy Now 0 Will Call
07��� You must call the inspepw wlien ready! Date Ready:
I certiy fhat i am ihe O�ICENSED CONTRACTOR OCOMPANY ❑ OWNER and hereby request inspection of Gie elecUical work at:
ina rena: nans un eAGK oF YELLOW COPY BOqRp OF ELECTRICITY COPY EB•OOD01A-14 8.7. 200Y