P - 79227� REQUEST FOR ELECTRICAL INSPECTION
�.� � C Q�, C�%� Minnesota Board of Electricity �
�J v �,) S �g2� University Avenue Suite 5-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Descri6e -usin the back of the white copy if necessary - the woric covered by this request:
XCE� ENERGY SAVEf�'S SWITCH
SERVICES /
$25
;UITS ! FEEDERS
0 to 200 Ampere @ $5
Above 200 Ampere @$10
2M, COMMUNICATION, REMOTE CONTROL, SIGNALING
;UfTS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus Ca� 5.50
3 to 12 Units @$50 Pe
Each Addiiional Unit @
Retrofit
Boom
l�l il IIl 111111f Ill II IN � 111 I I HI N III Il �l I IIN
9
Traffic
Fee a
JD f0 1
� Transformer 1 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 Inspection Trips Each Dwelling Unit @$60
(minimum total fee is $20) � i0,50
THIS AREA FOR INSPECiOR USE ONLY
I hereby cer5fy Mat I inspected the elechic� insfalla6on described herEin on tlie d�es stated:
--�_ _ __�__ --
R�699
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L 7 6$ 5 5 7 ��� "�/ �� �^
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Request Date: Rcugh�n Inspection R�uired? ❑ Yes Inspection Ofher Than Raugh-In: ❑ edy Now C7 4YI1 Call
d���� You must call the inspector when ready! Date Ready:
I certify that I am fhe C�{ICENSEO CONTRACTat 0 COMPANY 0 OWNER and hereby request inspection of the elecUical work at:
INBTRUCTONg ON BACK OF YELLOW COPV BOAR� �F ELECTRICfT`I COPV EB-OOOOtM14 8.1. 2002