P - 79269REQUEST FOR ELECTRICAL INSPECTION
1`� 1 O- 6 4 9� ��nnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
. (651) 642-0800 TlY/MRS 1-800�27-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -usin the back of the white copy if necessary - the work covered by this request:
XCEL ENERGY �SAVEF�'� SiMT�H
SERVICES / POWER SUPPLIES
0 to 400 Am re $25
407 to 80(l Ampere @ $50
Above 8(l� Ampere @ $75
CIRCUITS / FEEDERS
0 to 200 Ampere @ $5
Above 200 Ampere p$10
ALARM, COMMUNIGATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Li htin Retrofit $.25 er Fi�ure
Center Pivot Im a6on Boom $40
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5
Se arate Bondin Ins 6on $20
S iallns tion $30 Fbur
S ial Ins tion $.31 er Miie
THIS INSTALLATION MAY BE ORDERED DIS(
� ���` II �� �� �� ��) �� ��� II I�� �� ��� �� ��I �� ��I � I�
Traffic Signal Standard
5uoolemental Fee � $
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspec6on TriDS p $20
Investiaative Fee
(minimum total fee is $20) I �a.�d
THIS FREA FOR INSPFCTqi USE ONLY
I hereby certify that I inspected the electric� imtaNaton described herein on ttie daMS sUted:
- ---
— — ----
- �t46�9
—7-a
177Db490
, ��,��� � (�It���j �� 5("�
Request Date: Rough-in Inspection Required? ❑ Yes ❑ o Inspection Other Tha� Rough-In: ❑ ady NaN 0 Will Call
�7��!� You must call the inspeclor when ready! Date Ready:
I certi(y that I am tt�e ❑XICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
INSTRUCTONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY EB-OOOOtA-74 8. t. 2002