P - 79337� REQUEST FOR ELECTRICAL INSPECTION �
�� 7 7 3- 6 0 5 �9 Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
W❑ REMODEL 0 ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL Eh1ERGY SAVER..'S SWITCH
GENERAI FEES Outdoor Li htin Siandard $1
/ICES I POWER SUPPLIES Traffic Si naf Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Ampere i� $50 Transfortners u to 10 KVA $10
ALARM, COMMUNICATION, REMOTE GONtFiOL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Exh Svstem Device or Aooaralus Cd 5.50
3to',
Each
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Indudes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Taro Inspection Trips Each Dwelling Unit �$86
Fee
.Y DWELLINGS PER UNIT TOTAL FEE I
Units @ a50 Per Unit (minimum total fee is $20) $2�.50
�diti0n21 Unit @$25 rws u+En �a+irsvECraa use arar
I herebY ceNy that I inspec�d the electrical install�on descnbed herein on tlie dates stabed:
OTHERADDITIONALFEES ��l�Y� �r �`d
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I{I{I II� III1I I���) III��III II�) Ii�11f�i11�1�
L 7 7 3� l7 .5 9
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IECTED IF NOT COMPLETED WITHIN 12 MONTHS __ �
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Request Date: Rough-in Inspection Required? ❑ Yes Q'Itlo Inspedion Other Than Rough-In: 0(t�ady Now ❑ 4W11 Call
(j� f�Q jQq You must call the inspeclor when ready! Dafe Ready:
I certify that I am the C�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and he�eby request inspecfio� of tl�e elechicai work at:
IN87RUCTON3 ON BACK OF YELLOW COPY BOARD OF ELECTRICRY COPV � EB•00001M74 8.1. ZW2