P - 79280❑ REQUEST FOR ELECTRICAL 1NSPECTION
�� 1 1�- 5 2 8 � 821 UnrversBy Ave � eESu � S! 28, Saint Paul, Minnesota 55104
' (651)642-0800TTY/MRS 1-B00-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this requesh
X.CEL Eh�ERGY SAVER'S SWiTCH
GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffc Si nal Standard $5
� 0 to 4D0 Amoere (� S25 Suoolemental Fee {cil $20
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Mile
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{I��I I{lN 1111111�1 IIlN �III ({�I Il�l
1? 7 3 5 2 8 3
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and�or Power Supply up to 5D0 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum tota! fee is S20) � $20.50
i1N5AREA OfiNJSiECTIXiUSECMV
I hereby cerUfy that I inspec�d the electrical instaNation described herein on the dates st�ed:
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Request Date: Rough-in Irrspection Required? ❑ Yes CYNo fnspection Otiier Than Rough-In: LJii�ady Now LJ 1KII Call
Q jJ2Qj(j� You must call the inspecta when ready! Date Ready:
I ceAify that I am the C�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and heieby request inspection of the electrical work at::
INSTRUCTONS ON BACK OF VELLOW COPY BOARD OF ELECTRICITY CAPY EB-OW01lE14 8.1. 2002