P - 79343REQUEST FOR ELECTRICAL INSPECTION
�����- 611 7� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, (651) 642-080� TTYIMRS 1-800-627-3529 www.e/ectriciry.state.mn.us
] REMODEL D ADDITION ❑ REPAIR Describe -using the b�k of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVER'S SWft"CH
GENERAL FEES Outdoor Lighting Standard @$1
/ POWER SUPPLIES Traffic Sianal Standard C�a $5
CIRCUITS, CIRCUITS OF LESS THAN 5� VOLTS
3 to 12 UniN' @$50 Per Unit
E2ch Additional Unit @ $25
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� Transfortner / Power Supply for Signs / Outline Lighting @$5
ONE 8 TWO �AMILY DWELLINGS, EACH UNiT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Fee
(minimum tofal fee is $20) � $20.50
THIS MFA FOR INSPELTOR USE ONLv
I hereby cer6ty tlY�at I inspecled the elecbical installaGOn described herein on tAe d� slated:
,�o a c{ C� l&�' S�
OMPLETED WITHIN 12 MONTIi
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Request Dffie: � Rough-in Inspection Required? ❑ Yes C3�No Inspedion Olher Than Rough-In: OReady Now � Will Call �
�9 f'Zd(� You must call the inspector when ready! Date Re�y.
I cerfify that I am the C�ICENSED CONTRACTOR QCON�ANY CJ OWNER and hereby request inspection of the electrical work at::