P - 79199REQUEST FOR ELECTRICAL INSPECTION
�� 7 6 8- 519 � Minnesota Board of Electricity ;- . ;
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �
v (651) 642-0800 TlY/MRS 1-800-627-3529 www.electricitystate.mn.us f
i
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -usin the back of the white copy if necessary - the work covered by this request:
XCE� ENERGY SAYEt�'S S�MTGH
GENERALFEES
Traffic Sianal Standard
Transformers over 10 KVA $ 20
Transformer / Power Suppty for Signs / Outline Ligh6ng �$5
ONE & 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 �$80
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unii (minimum total fee is $20) I 20,50
E2Ch Additi0nel Unit @ $25 r�rsr,aFnFCarc�svECroausEaar
I hereby certify that I inspected the electrical installation destribed herein on the dates stated:
� a
Hour
� R4�9�
I�1! ����! 11 II1 II I� 1� ��� �� 1� II ��� il � I I�
176195L99 �C�C�Z"b��"l�
� SO
Request Dffie: Rough-in Inspection Required? � Yes ❑"No Inspection Other Than Rough-In: ❑I�eady Now � Will Call
1�7��%� You must call the inspeclw when ready! Date Ready: _
I certiy that I am the ❑�(ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of fhe elecfical work at:
INS7RUGTONB ON BACK OF YELLOW COPY BOARD OF ELECTRICITY CAPY E&00001M14 8.1. 2002