P - 80600REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Eleciriciiy
' 1-380-331 � 1821 Universiry Avenue Suite 5�128, Saint Paul, Minnesota 55104 �'
(651) 642-0600 TTY(MRS 1-8�0-627-3529
www. electricity,state.mn. us
� Identity tha wo�k wvered by tnis request'.
'AIR JCCEL ENERGY SAVER'S SWITCH
Oultlwr Li hAn Standartl B$1 �
Tramc Si nal Stanpard � $5
Su lemental Fee � $20
Transiortners u to 10 KVA �$1�
T�anstormers over 10 KVA 8$20
T�ansfom�ers ( Powe� Su For Si I Ou111ne 11 in �$5
ONE & N/0 FAMILY DWELLINGS, EACH UNIT
Includ¢s ihe Service andor Power Supply up to 500 Amperes, All
SIGNALING CiRUits aiM Two Inspeclion Trips Each Dwe�Ping Unit �$ep
Adtlitionallnspeclion Trips � $20
Imesti ative Fee
EES Reinspection Fae � $20
TOTHLFEE !
mVnimum totai fee is $20
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>RDERED DISCONNECTE OT COMPLETED WITHIN 18 MONTH;
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� U8/1 /Nl � Vou musl call Ihe inspedor when reatly! � Oate Reatly: �
I certify ihat I am ihe L� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe eledrical work at: