P - 79284- REQUEST FOR ELECTRICAL INSPECTION �
� � � � � � � � ^ a 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
NEW ❑ REMODEL ❑ ADDITION D REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVER'S SWiTCH
SERVICES / POWER SUPPLIES
0 to 400 Amcere C� 825
CIRCUITS, CIRCUITS Of LESS THAN 50 VOLTS
Addifional Unit @
Rehofit
Traffic Siqnal Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips E�h Dwelling Unit @$80
t (minimum total fee is $20) � $20.50
TMS AREA Fdi INSPECiqi USE pdY
I hereby cerUfy that I inspected the electrical installaUOn described herein on the dates stated:
)DITIONAC FEES � dG G� G �7 /2 �
Fixture ,., �
il�l IIIII II�I IIIII {Ii{t�111IIII! IIE�I IIlII i�il
17735325
%2 —2 —o''`�
� �^�
•.• s
Request Date: Rough-in Inspection Requirod? ❑ Yes ❑�Ro Inspedion Other Than Ragh-In: ORbady Now LJ Will Call
Q��Qf Q� You must call the inspector when ready! Date Ready:
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion of the electrical work at:
IN87RUC1fON5 ON BACK OF YELLOW COP'( BOARD OF ELEC7RICITV COPY � E&00001A-14 8.1. 2002