P - 79310❑ REQUEST FOR ELECTRICAL INSPECTION
��'7 �� �['7 0 C, Minnesota Board of Electricity
( J! �l 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricirystate.mn.us
NEW ❑ REMODEL ❑ ADDITION 0 REPAIR Describe -usin the baek of the white copy if necessary - the work covered by this request:
XCEL ENEfiGY SAVE4�'S SWITGH
GENERAL FEES Outdoor Li htin Standard $t
SERVICES 1 POWER SUPPLiES Tr�c Si nal Standard $5
0 ro 400 Am re$25 Su lementaf Fee $20
401 to 800 Ampere (a? $50 Transformers up to 10 KVA @$10 __
Above 200 Am ere $10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addftionai Ins tion Tri s$20
Each S stem Device or A aratus $.50 Investi ative Fee
ADDITIONS TO THE GENERAL fEES ReinspecGon Fee (�a $20
........_. _..---°--- � - •- - — --
3 to 12 Units @$50 Per Unit (minimum total fee is $20) $z0.5d
E2Ch Additi0n21 U�it @$25 �ws naFn Faa ws�croa use aar
1 hereby certify that I inspected Me elecbical installation describetl herein on the da0es sta8ed:
OTHER ADDITIONAL FEES
Linh6no Retrofit � 5.25 oer Fixlure � 6`J Y'� � ���5�
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KeQues� uate: Rough-in Inspection Required? ❑ Yes d'hlo Inspection Other Than Rough-In: ady Now C7 VYII Call
09/20/04 You must eall the inspedor when ready! oac� R�ay:
I certify tt�at I am ihe C�{.ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
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