P - 79219REQUEST FOR ELECTRICAL INSPECTION
��` 1 V�- 5 4 5� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYIMRS 1-800-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -usin the back of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVEl�'S SWlTCH
JICES I PC
0 to 400 Ar
401 to 800
ALARM, COMMUNICATtON, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Oevice or A aratus a$.50
ADDITIONS TO THE GENERAL
Each Additional Unit @
Siandard Ca? $t
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes lFie Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �,i1$80
(minimum total fee is $20) � 20,fi0
T HIS AREA FpF NSPECTCR USE CK Y
I hereby ceAify that I inspecled the electrical installa6on described he2in on the daOes stated:
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Request Date: Rough-in Inspection Required? ❑ Yes Inspecfion Other Than Rough-In: ❑ ady Now � Will Call
D%%3�� You must call the inspecta when ready! Date Ready:
I certify Uiat I am the �CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
INSTRUGTIONS ON BACK OF YELLQN COPY BOARD OF ELECTRICITY COPY EB•00007M14 8.1. 2002