P - 79285� REQUEST FOR ELECTRICAL INSPECTION
�.— 7 7 3- 5 3 3❑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.electricity.state.mn.us
Q NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
?�CEL EiVERGY SAVER'S SVVfiCH
GENERAL FEES Outdoor Li htin Standard $1
SERVICES I PbWER SUPPLIES Traffic Sianal Standard (�a $5
401
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Each
Pivot
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17735333
� Transformer / Power Supply for Signs / Outline Lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two InspecGon Trips Each Dwelling Unit �$80
TOTAL FEE I
(minimum total fee is $20) $20.50
THIS MEA Fpt NiSPECiOR USE Mv
I hereby certry ttiat I impeched Me electrical insiaNaton described herein on H�e dales stated:
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Request Date: Rough-in Inspectian Required? ❑ Yes Q' iVo Inspection Other Than Rough-In: L3R�ady Now LJ 41R11 Call
09(20JQ� You must call the inspedor when ready! Date Ready:
I ceilify ihat I am tt�e C�ICENSED CONTRACTOR OCOMPANY ❑ OWNER and hereby request inspection of the efectrical work at:
INBTRUCTIONS ON BACK OF YELLOW COPV �ARD OF ELECTRICITV CAPY . EB-00007Mt4 8.1. 2002