P - 79350� ❑ REQUEST FOR �LECTRICAL INSPECTION
�� 1 i�- 619 O 8121 UnotersBy Aven� e 3u terS1128, Saint Paul, Minnesota 55104
• (651)6A2-OS00 TTY/MRS 1-800-627-3529 www.etectnctty.state.mn.us
NEW ❑ REMODEL ❑ ADDITION 0 REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCE� ENERGY SAVER'S SiMTGH
Standard an $1
I POWER SUPPLIES
�0 Am re $5 ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
2�� Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
1MMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri $20
3vstem Devir.e or Aooaratus na $.50 Investiaativ2 Fee
ADDfTfONS TO THE GENERAL FEES Reins tion Fee 5z0
WELLINGS PER UNIT TOTAL FEE
>@ S50 Per unit (minimum total fee is $20j �20.50
mel Unit @$25 rws nnen Faa ir+scECTOa usE ara.
I hereby certiry that I inspected Ne eleclrical imtalla6on described herein on riie dates sla�ed:
e
Hour
INlI1Nl ��� j
1� � Ili {i l� 11 I II H il1 I I�l I� 1� il �{ I
1,773(�190
o� �S U
Repuest Date: �Roughin Inspection Required? � Yes O�F10 Irupedion Other Than Rough-In: �I�Lady Now O Will Call
��(3%� You must call tF�e inspector when reatlyl Date Ready:
I cer�fy that I am ttie �CICENSED CONTRACTOR ❑COMPANY 0 OWNER and hereby request inspection of the electrical work aY:
INSIRUCTONB Wl BACK OF YEl10W COPY BOARD OF ELECTRICIT`/ COPY E&00001M74 8.7. 2002