P - 79236REQUEST FOR ELECTRICAL INSPECTION
�_� "7 � p� 5 C�� Minnesota Board of Electricity -
� 0 V 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.e[ectriciry.state.mn.us
NEW ❑ REMODEL O ADDITION O REPAIR Describe -usin the back of the white copy if necessary - the work covered by this request:
XCEL EPfERGY SAVEF�`S SWiTCH
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am ere $50
Above 800 Ampere $75
CIRCUITS / FEEDERS
0 to 200 Ampere . $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNAL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System DeviCe or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMiLY DWELLINGS PER UNIT
3 to 12 Units aLl $50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL �EE
Li htin Retrofit $.25 r Fixture
Center Pivot Irti ation Boom $40
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5
Se arate Bondin Ins tion $20
S ial Ins tion $30 r Hour
S ial Ins tion $.31 r Mile
THIS INSTALLATION MAY BE ORDERE[
� i��� �� �� �i i`i ii �i� �� i� u ii� «i�i � �i� � �� � ���
1 7 6 8 5 6 7 8
Traffic
Fee $2D
un to f0 KVA
2a
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspect+on Trips Each Dwelling Unit @$80
(minimum total fee is $20} I 20.50
iH15 NREA FOR INSPECiOR USE ONLY
I hereby certify lhat I inspec0ed the electrical insWlaBOn deuriDed herein on Me dates sfafed:
ISCONNECTED IF NOT COMPLETED WITHI
�4���
_l��`� �! +� b�r
Ut
._ / ">— d
��
�•
Request Date: Rough-in Inspection Required'? LJ Yes LJ T!o Inspedion Other Than Rough-In: LJReatly Now � Will Call
���0� You must call the inspeclor when roady! I Date Ready:
I certiy that I am the O�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
iN87RtICTONS ON BACK OF YELLOW COP'Y BOARD OF ELECTRICT' COPY E&OOOD1M14 8.1. 2002