P - 79344❑ REQUEST FOR ELECTRICAL INSPECTION
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�� 1 1 J- 612 5 8'21 UnrversBy Aven� e 8u terS-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this requesl:
XCEL ENERGY SAV�R'S SWlTCH
JICES / I
0 to 400
ALARM,
CIRCUITS OF LESS THAN 50 VOLTS
rraffic
Fee
0
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$60
3 to 12 Units @$50 Per Unit (minimum total fee is $20) � �lU.SU
E2ChAddi6on21Unit(_,al$25 rHisnaEr�FOrsMUVecroausEw.r �
1 hereby certify that I inspected the electrical installation deuribed herein on the dales sta6ad:
OTHER ADDITIONAL FEES ��� �` G� �G 3
htin Retrofit $.25 er Fixture
Center Pivot Irtipation Boom C� $40 R01�"'" °AT
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17736L25
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Request Date: Rough-in Inspettion Required? ❑ Yes Inspedion Other Than Rough-In: dy Now � Will Call
��/2Q(Q� You must call the inspector when ready! Date Ready:
I ceRify that I am the Cj�ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby reqt�st inspection of the electrical work at:
INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICRV CAPV EB-0OOO1M14 8.7. 2W2