P - 79193REQUEST FOR ELECTRICAL INSPECTION
,� �(� O- 512 � Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.eiectricity.state.mn.us
❑ ADDITION ❑ REPAIR Describe -usin the back of the white copy if necessary - ihe work covered by this request:
XCEL ENERGY SAVEf�'S SWITCM
GENERALFEES
ALARM, COMMUNICATION, REMOTE CON7ROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Moaratus Ca? $.50
25 oer FuAure
� Ilil II � II III II I II I! �I II Ili li I� II III II f� ! I�I
�7685L24
ONE 8 TWO FAM�LY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � 20.50
iN15 MEA Fqi INSPECTOR USE OKY
I hereby certify tliat I inspecled Me elechical installa6on tlescribed herein on Me dates stated:
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Request Date: I Roughin Inspection Required? ❑ Yes �"No InspeMion Other Than Rough-In: �R�ady Now O VNII Call
�7��� i You must call the inspecla when ready! Date Ready:
I certiry that I am the C�{ICEN$ED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspec6on of ihe eiecUical work at:
INSTRUCTIONS ON BACK OF YELLOIN COPY BOARD OF EIECTRICITY COPV EB-0OOO1M74 8.1. 2(p2