P - 79179REQUEST FOR ELECTRICAL INSPECTION
� �, "7 � �7 ,�„ Q Q 0 � Minnesota Board of Electricity - .
I � J V 1621 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 -using ihe back of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVER'S SWITCH
AFNFRAI FFFS Outdoor Liahtina Standard na. $1 ._
0 to 400
�MMUNICATION, REMOTE CONTRO�, SIGNALING
CIRCUITS OF LESS THAN 50 VOLTS
V
lell II IN II �I �I ill � III I� �i I�NI I! III II III I I�
�,757`i806
� Transfortner / Power Supply for Sians I Outline Lighhng (,N �5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, A!I
Circuits and Two Inspection Trips Each Dwelling Unit �$80
TOTALFEE
(minimum total fee is $20) 20.50
THIS MEA Fqi INSPECiOR USE ONLY
I hereby certiry that I inspected the electrical insfallation described herein on tlie da�s sta0ed:
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Kequest Date: Rough-in Inspection Required? LJ Yes L? No Inspection Other Than Rough-In: L']Reedy Nav U Will Call
d � li ���{ You must call the inspector vfien ready! Date Ready:
I certify that I am the �I UCENSED CONTRACTOR ❑ COMPANY 0 OWNER and he�eby request inspection of tl� e�l worlc at:
INSTRUC710N8 ON BACK OF YELLONf COPY BOARD OF ELECTRICT' CAPY EB-0OOO1M14 8.1. 2002