P - 79181,_. REQUEST FOR ELECTRICAL INSPECTION
� 1 � � [ � � (] p � � Minnesota Board of Efectricity -
d� J .7 0 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(65t) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVER'S SWITCH
GENERAL FEES Outdoor Liah6nq Standard @$1
SERVICES I POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus $.50
ADDITIONS TO THE GENERAL FEES
Per Unit
@ $25
Lb htin Retrofit $.25 er Fixture
Center Pivot Irti alion Boom $40
Manufacwred Home Park Lo1s S25
Recreational Vehicle Park Sites $5
Se arate Bondin ins tion $20
S ial Ins tion $30 er Hour
S ial ins tion $.31 Mile
THIS INSTALLATION MAY BE ORDEREC
1 lill II III II III ll �II II � 11 III II ��I lIL II I� I�
�,7579822
ONE � TWO FAMILY DWE�LING;
Includes the Service andlor Power
Circuits and Two Inspection Trips
Fee
up to 500 Amperes, All
ach Dwelling Unit @ $80
(minimum total fee is $20) � 20.50
THIS AREA FOR Il6PECTGR USE OK�
I hereby cerUfy that I inspected the electrical insUlla6on described herein on ttie da[es sfa@ed:
�a
Ch.�� 3
o?O - SO
Request Dffie: Rough-in Inspection Required? ❑ Ves � No Inspection O[her Than Rough-In: �Ready Nax ❑ V1NII Call
�i�i ��� You must call the inspettor when ready! Date Ready:
I certi4y ttrat I am the i�l LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tl�e elechical work ah:
M8TRUCTONB ON BACK OF YELLOW COPV BOARD OF ELECTRICITV COPY EB-00001M76 8.1. 2002