P - 79176REQUEST FOR ELECTRICAL INSPECTION
. � � � C � � (� � � � Minnesota Board of Eleciricity -
J J 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TlY/MRS 1-800-627-3529 www.electricity.state.mn.us
NEW ❑ REMODEL O ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVER'S SWITCH
GENERAL FEES Outdoor Ligh6ng Standard @$1
0 to 400
401 to 8�
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
'ALLATION MAY BE ORDERE'.
+ + +++++ I�� �I�
IIII II�� �I (II II III (I �� II I�I II �I II III
a�7579772
Su lemental Fee @ $20
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transfortner / Power Su I for Si ns I OuGine Li h6n $5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliing Unit �$80
TOTAL FEE I
(minimum total fee is $20) 20.50
iHIS MFA Fq21f15PECipi USE OPLY
I hereby ceAify that I inspected the elechical installation described herein on Me dates staled:
��
/� ��15� �-_
� � �
�-SO
�rtequest uate: Rough-in Inspection Required? LI Yes No Inspection Other Than Rough-In; y Now � Wfll Cell
� i f �.�J%�Q� Yau must cal! the inspecta when ready! Date Ready:
I certify that I am Uie xl LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby req�st inspection of tl�e electrical work at:
INSTRUCTONB ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPV E&00001M14 8.7. ZW2