P - 79302' REQUEST FOR ELECTRICAL INSPECTION �
%% Minnesota Board of Electricity !�
�� 1 I�- 5 6 2 2 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 � '
(651) 642-0800 TfY/MRS 1-800-627-3529 www.electriciry.stote.mn.us
NEW O REMODEL ❑ ADDITVON � REPAfR Describe -using the back of the white copy'rf necessary - ihe work covered by ihis request:
XCEL ENERGY SRV�R'� SWITCH
GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Amcere (� $25 Supplemental Fee @$20
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus [�a $.50
FEES
Pivot
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II�II�I��� I�III
1 7 7 3 5 6 2 2
Transfortners u to 10 KVA $10
Transfortners over 10 KVA $ 20
Transformer / Power Supply for Sipns / OuUine Liqhting @$5_
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Inscection Trios (� $20
(minimum total fee is S20) � $20.50
iH15 AREA FOR INSPEGTOR USE OOIY
I hereby certi(y that I inspected the elec6ical installation described herein on tl�e da�s sta6ed:
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Request Date: Rough-in Inspection Required? O Yes ❑1qo Inspection Other Than Rough-In: ❑IQ�ady Now � WNI Call
Q�(20l0� You musl call the inspector when ready! Date Ready:
I ceRify that I am the ❑j�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and heieby request inspectiai of Uie elecUical work ax:
INSTRUC710NS ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPV E8�00001A-14 6.1. ZaRe