P - 79308REQUEST FOR ELECTRICAL INSPECTION
1����- 5 6 8 Minnesota Board of Electricity
} � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-080011Y/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL O ADDITION ❑ REPAIR Describe -using the b�k of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVER"S SW�i'CH
�ENERAL FEES Outdoor Lighting Standard @$1
RVICES! POWER SUPPLIES Traffic Sianal Standard (�a $5
401 to 800
IALARM, COMMUNICATION, REMOTE CONTROL, SIGNALIN�
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Hour
Mile
i�oi ii i� ii iii ii � ii iii ii iii ii iii ii �i ii �ii i i��
1, 7 7 3 5 6� 9
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspec6on Trips Each Dwelling Unit @$80
TOTALFEE
(minimum total fee is $20) $20,50
iw5 MFA FIX1 iNSPELTOR USE OKY
! hereby certify fhat I inspec�d tl�e elec4ic� insfallation described I�erein on the dales stated:
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neques� vace: Rough-in Inspection Required? O Yes ❑'P5o Inspection Other Than Rough-In: � dy Now O Wdl Call
Q�Z�iQ� You must call the inspeclor when ready! . Date Ready: � �
I certify that I am the ❑j�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of fhe electrical work at::
ma i rc�cn�ns vN BACK OF �ELLOW COPV BOqRp OF ELECTRICITY COPV � E&OOOOtA•74 8.7. 2002