P - 79287REQUEST FOR ELECTRICAL INSPECTION
�����- 5 3 6❑6 Minnesota Board of Electricity -
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 O REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCE� EPlERGY SAVER'S SV4I�TCH
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
401 to B00 Am re $50 Transformers u to 10 KVA $10
Above 800 Am e$75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer I Power Su I for Si ns / Outline Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Iricludes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri s $20
Each Svstem Device or Anoaratus �? $.50 Investiaative Fee
Center Pivot Irriqation Boom
TOTALFEE
(minimum total fee is $20) $20,50
THIS RRE/. Fqi �NSPECT00. USE OtYV
I hereby ceAify thal i inspected the electrical installation described herein on Me da�s staled:
���F-� Ci��7lg
•IL .0
" III���I� � �
II�IIIIIIII�IIINlllliiilllii�lllill �j�
1 7 7 3 5 3� 6 �"
� r�
Request Date: Rough-in Inspection Required? ❑ Yes I�pection Qther Than Rough-In: ❑ y Now � VY41 CaN
�9�20 f� You must call the inspecta when ready! Date Ready:
I certify that I am the C�ICENSED CONTRACTOR 0 COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
INSTRUCTONS ON BACK OF YELLOW COPY eonsto oF EtFC�icm coPr •-�-�^^� •^ ^-� ••---