P - 79165REQUEST FOR ELECTRICAL INSPECTION
��� J 1- 9 6 6� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-OBOOTIY/MRS1-800-627-3529 www.etectricity.state.mn.us
NEW O REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by ihis request:
XGEL ENERGY SAYER'S SW4TCH
GENER4L FEES Outdoor L' h6n Standard $1
SERVICES! POWER SUPPLIES Traffic Signal Standard @$5
ALARM, COMMUNICATION, REMOTE GONTROt
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEE;
Liahtinq Rehofit � 5.25 oer Fixlure
11111111� II I!f 1111I II IN N II{ N�i 11111 li � i iiil
1,7579665
ONE & TWO FAMILY DWELLINGS, EAGH UNIT
Includes the Sen�ice andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � 20.50
iH15 AREA FOfI INSPECipi USE 011V
l hereby ceNry tl+at I inspeckd the electrical i�talla6on described hMein on the dates sialed:
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Requesc uaie: ( Ro�ghin Inspection Required? U Yes CJ No Inspection Otlier Than RWgh-In: IJReedy Now LJ Will Call
dili �Q�i You must call the inspector when ready! Date Ready.
I certify that I am the Xl UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tl�e elecUicaf work at:
INS7FtkICTON80N BACK OF YELLOW COVV BOARD OF ELECTRICITY CAPY EB-0O�O1M74 8.7. 2002