P - 79348REQUEST FOR ELECTRICAL INSPECTION �
% � Minnesota Board of Electricity - _
� /� 1�- 617 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �-'
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
• NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCE� Et�lERGY SA'VER'S SWITCH
GENERAL FEES Outdoor Li htin Standard $1
SERVICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
d01 fn A00 Amnere rni $50 Transformers uo to 10 KVA (�a $10
AIARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus $.50
ADDITIONS TO THE GENERAL FEES
Center Pivot Irtigalion Boom @
Manufactured Home Park Lots I
Recreationa! Vehicle Park Sites
Mile
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Ilill lllllll�l llail l�lll IIIII lllll II�I II� I1�1
L 7 7 3 6 1 7 4
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andior Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum tofal fee is $20) � $20,5a
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I hereby certi(y thffi I inspected the electrical installafion described herein on the d�es sqted:
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Request Date: Rough�n Inspedion Required? Yes Inspedion Other Than Rough-In: O ady Now � Will Call
Q����Q You must call the inspector when ready! Date Ready.
1 certify that I am the C}�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec�on of the elecUical work at:
IN57ItUGTONS ON BACK OF YELLOW COP1/ BOARD OF ELECTRICITV COPY EB-00001M14 8.1. 20�