P - 79744_-�r �
REQUEST FOR ELECTRICAL INSPECTION
���� 0-16 7� Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYIMRS 1-800-627-3529 www. electricity.state. mn. us
NEW ❑ REMODEL ❑ AODITION ❑ REPAIR Describe -using the back of the white copy it necessary - the work covered by this request.
ISGEL ENERQY SAVER,S SWiTCH
401 to 800
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
fIFAMILY DWELLINGS (PE
3 t� 12 U�its @$50 Per Unit
Each Additianal Unit p $25
Hour
I i�l II lil I1 i� ii �l{ II Ili f�Hi II IH {{ �I II 1II i li�
1, 7 5 C71 6 7?
Traffic Signai Standard
Suoolemental Fee (a� $
10
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
I�cludes the Service and/or Power Supply up to 500 Amperes, All
Circu+ts and Two Inspection Trips Each D�xeHi� Unit @$60
Additional Inspection Trips $20
�Inves6aative Fee
(minimum total fee is $20) � 20,50
iH15 MER FIXt INSFECTqi USE plY
I hereby certify that i inspected the electrical installation described herein on tlie datrs staBed:
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Request Date: Rou9han Inspection Required? ❑ Yes Nc I�specti� Other Than Rough-In: ady Now � Will Calt
9?J13/a2 You must call the inspector wM1en ready! Dafe Ready:
I certify that I am the i�.l UCENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the elecfical work at:
INi7RUC710N8 ON BACK OF YELLOW COPY BOARD OF ELECTRIGTV COPV E&0�001A•14 8.7. 2002 ��