P - 79205�°�?6��-525�
NEW ❑ REMODEL ❑ ADDITION ❑
XCEL
GENERALFEES
REQUEST FOR ELECTRICAL INSPECTtON
Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
.: :
(651)642-0800TTYlMRS1-800-627-3529 www.electricity.state.mn.us
� Describe: usingthe back of the white copy if necessary - the work covered by this request:
Traffic
Fee @ $20
uo to 10 KVA
0 to 200 Am e $5 ONE 8 TWO FAMILY DWELLINGS, EAGH UNI I
Above 2(16 Am re $10 Includes the 5ervice and/or 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 Additional Ins tion Tri s $20
Each Svstem Device or Anoaratus a(� $.50 Investipative Fee
TOTALFEE {
(minimum total fee is $20) � 20.5�
i HIS PREA FOR lNSPECTOR liSE Cf0.Y
I hereby certify that I inspected the electrical instellaUon described herein on the daffis stated:
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ttequest uate: RougMin inspection Required? LJ Yes U No I Inspection Other Than Rouglrin: OReady Now L7 Will Call
fl7��� You must call the inspector when ready! � Date Ready.
I certify that I am the ��ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
INS7RUC710NS ON BACK OF VELLOW COPY BOARD OF ELECTRICITY CAPY EB-0DOOtA•14 8.7. 2002