P - 79201REQUEST FOR ELECTRICAL INSPECTION
� � ( � � - 5 21 � Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104
(651) 642-OSOO TTY/MRS 1-800-627-3529 www.electricity.state.mn.us "
NEW 0 REMODEL ❑ ADDITION ❑ REPAIR Describe -usin the back of the white copy if necessary - the work covered by this request:
XCEI ENERGY SAVEf�'S SWITGH
ACES I POWER SUPPLIES
0 to 400 Amcere (a? $25
CIRCUITS OF LESS THAN 50 VOLTS
to 12 Units @$50 Per Unit
Center Pivot Irrioation Boom
il�ll �I�I ���� I���� ���I� �I� IIIII Illll ��1� (��
L 7 6 8 5 2 1 5
Fee
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Owelling U�it @$f
(minimum total fee is $20) � 20.50
iH15 FAFORINSPECTORUSE0�1Y
I hereby certify that I inspec[ed the electrical installafion described herein on the da�s stffied:
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I Request Date: Rough-in Inspection Raquired? ❑ Yes �'t�o Inspection Other Than RougMn: ai��aady Nwa a Will Call
�7��iQ1: You must wll the inspector when ready! Date Ready:
I cefify that I am ihe DLICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
INSlitUCTONS ON BACK OF VEILOW COPY BOARD OF ELECTRICITV COPV E&00001M14 8.1. 2002