P - 79318REQUEST FOR ELECTRICAL INSPECTION
� r�� s� r��� � Minnesota Board of Electricity
S 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
° (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
fiON ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
?CCEL ENERGY SAVER'S SWITGH
SERVIGES i POWER SUPPLIES
CIRCUITS OF LESS TNAN 50 VOLTS
fIFAMILY DWELLIN6S (PE
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Mile
' I) III I �
i i��l � III H Iii II III �I IH N lil 111I1 II �1
�,77358],2
Transfortners uo to 10
� Transformer I Power SuDP�Y for Signs / Outline LighGng @ S5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the 5ervice and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$60
(minimum total fee is $20) � �Z0.�0
THiS AIEEA FOR INSPECiOR USE 016' Y
I hereby ceitify that I inspected the electricai insWla6on Aescribed herein on the dffies stafed:
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Request Date: Rough-in Inspedion Required? ❑ Yes �No Inspection Other Than Rough-In: �RLady Now fJ VY�II Call �
agt20t� You must call the inspecta when ready! �ate Ready: �
I certity that I am the C�.ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby ►equest inspection of tlie elechical work at: