P - 79175� REQUEST FOR ELECTRICAL INSPECTION
��]� % � Minnesota Board of Electricity
� 1� 1� 9 7 6 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 <; '
(651) 642-0800 TlY/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 SWITCH
/POWER
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
ispection � $.31 per Mile
�ALLATION MAY BE ORDEREI
I��l II III II III II �II O I� II III II III II I� II III I III4
.L 7 5 7 9 7 6 4
Standard
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Supply for Siqns I OuUine Lightinq �$5
ONE � TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, NI
Circuits and Two Inspection Trips Each Dwelling Unit @$60
Fee
(minimum total fee is $20) � 20.50
iH15 AREA Fpt INSPECiIXY USE WY
I hereby certify that I inspected the electrical insfallation deuribed herein on the da�ffis sfa0ed:
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Request Date: Rough-in Inspeclion Required? Yes No Inspedion Other Than RougMn: �Ready Now O VYII Call
0111512004 You must call the inspector when ready! oare Ready:
I certif�r that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the etectrical wo�C at:
INSTRUCTONS ON BACK �F YELLOW COPY BOARD OF ELECTRICITY COPY EB�UO�OVM14 8.1. 2UU2