P - 79177� REQUEST FOR ELECTRICAL INSPECTION ' �`
.�� i C i�,,, (] � Q� Minnesota Board of Electricity !-
r � r � v 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55iO4 —
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us "�
NEW ❑ REMODEL 0 ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the vrork cove2d by this request:
XCEL ENERGY SAVER'S SWITCH
GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPUES Traffic Signal Standard @$5 .
ALARM, COMMUNICATtON, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device a Apparatus @$.50
ADDITIONS 70 THE GENERAL FEES
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Retrofit �1$.25 ner Fixture
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer I Power Supply for Signs I OuUine Ligh6nq p$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Paxer Supply up to 500 Amperes, All
Circuits and Txro Inspection Trips Each Dwelling Unit �$80
(minimum total fee is $20) � 20.50
TMS AFEA Fqi iNSPECiOR USE p1Y
I hereby ceNfy that I inspecled Me electrical installa6on described herein on tlie d�es stated:
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Request Date: Rough�n Inspection Required? ❑ Yes No Irupection OtFrer Than Rough-In: y Now � Will Call
Q i�i'�0� You must call the inspecta when ready! Date Ready:
I certify that I am ri�e �I LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
IN87RUGTONB ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPY EB-0OOD7M4 8.1. 2002