P - 79215REQUEST FOR ELECTRICAL INSPECTION
�` I� V- 5 3 7� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
NEW ❑ REMODEL C] ADDITION ❑ REPAIR Describe -usirt the back of the white copy if necessary - the work covered by ihis request:
X.CEL ENERGY SAVEF?'S SWITCH
0 to 400 Ar
401 to 800
iITS, CIRCUITS OF LESS THAN 50 VOLTS
ach System Device or Apparatus @$.50
ADDITIONS TO THE GENER4L
FAMILY DWELLINGS (PER UNIT)
to 12 Units @$50 Per Unit
Illl �� �III II III IINI IIIII IIIN �Iil fi� I�
1�76�5371
Traffic Signal Standard
Supplemental Fee @ $
Transfortners up to 10
7ransformers over 10 �
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, Ali
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
(minimum total fee is $20) I 20.50
THiS AREA FOR INSPEGTpi IlSE IXJIY
I hereby certify Mat I inspected the electrical installa6on described herein on Uie d�es sq�d:
� cra c� R pl� i fL
R4699
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Request Date: � Rough-in Inspection Required? LJ Yes LJ No I Inspedion Other Than Rough-In: L712eedy Now L] Wlill Call
�7�0� You must call the inspector when ready! Date Ready:
I certify that I am the ❑�ICENSED CONTRACTOR OCOMPANY ❑ OWNER and hereby request inspecb6on of the electrical wwk at:
INSTRUCTONB ON BACK OF VELLOW COPY BOARD OF ELECTRICITY COPY E&00001M14 &1. 2002