P - 79325' REQUEST FOR ELECTRICAL INSPECTION �
1� f 1�- 5 9 2 9� Minnesota Board of Electricity -
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TfY/MRS 1-800-627-3529 www.electriciry.state.mn.us
NEW ❑ REMODEL O ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
?CCEL ENERGY SAVER'S SVVITGH
GENER4LFEES
I Above 200 Ampere @$10 I
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
ALLA
Transformers u to 10 KVA 810
Transformers over 10 KVA .$ 20
Transformer / Power Supply for Siqns / OuUine Liqhting p$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes U�e Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Per unit (minimum total fee is $2�) � $?Q.SQ
@$25 rws naFA roa rtttvECion usE orxr
I hereby certiy that I inspected Me eleclrical installation described herein on the dates sfaMd:
HER ADDITIONAL FEES �,p0 ��t 6`�Z y
.95 ner Fiztura
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)MPLETED WITHIN 12 MONTHS
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°`+"°" 1°'0. Rough-in Inspection Required? ❑ Ves �'�ip Inspedion Other Than Raugh-In: ❑ ady Now O Will Call
���i� You must call the inspecta when ready! Date Ready
I certify that I am the �ICENSED CONTRACTOR 0 COMPANY ❑ OWNER and hereby request inspection of the elecUicai work at:
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