P - 79163REQUEST FOR ELECTRICAL INSPECTION
�"���- 9 6 4 Minnesota Board of Electricity
.�/ O 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 0 REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVER`S SWi'f�H
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
;UITS I FEEDERS Transformer / Power Su I for Si ns / Outline L' htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service andlor Power Supply up to 500 Amperes, All
2M. COMMUNICATION. REMOTE CONTROL. SIGNALING Circuits and Two Inspecfion Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Mile
�II � �I II III !I III � IN ��1111111141 �1 !! �I I l�l
l,?579640
(minimum total fee is $2�) � 2�.5�
THiS ARFA Fp21N5PECTp2 USE p1v
I hereby certiry that I inspecled the elecCical installa6on described herein on the da�s sfaled:
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D WITHIN 12
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rcequest uate: Rough-in Inspection Required7 ❑ V� Q No Inspedion Other Than Rough-In: �Ready Now ❑ Will Call
1�i�i ��� Vou must call the inspectw when ready! Date Ready:
I certify that I am ihe :�I LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby r�equest inspectiai of the electrical work at:
INSTRUCTIONB ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPY EB.00OOIM7/ 8.1. 2002