P - 79223� REQUEST FOR ELECTRICAL INSPECTION �
.�� 1� O- 5 4 9� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS t-800-627-3529 www.elec[ricity.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 SAVEi�'S SWITCH
GENERAL FEES Outdoor Liah6na S:andard (�a $1
SERVICES I POWER SUPPLIES
0 to 400 Amcere na $25
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Anuaratus [d $.50
fo 12 Units
OTHER ADDITI01
Retrofit @ $25 per Fixture
'ivot Irriaation Boom O 840
I Iill � I� II III II �II II III ii � 11 I I I I I ill II �I I I�I
�'I L7685496
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Reins Gon Fee $20
TOTALFEE
(minimum total fee is $20) 20,50
THIS AItEA FOR INSPECiIXi USE MY
I hereby cerfi(y that I inspec0ed the eleclric� insfalla6on described he2in on the dales smled:
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eunaeoina+r�oor�EO oare
IECTED IF NOT COMPLETED WITHIN 12 MONTHS
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nequesc ua�e: Rough-in Inspection Required? p Yes ❑ Inspedion Other Than Rough-In: ❑ eady Now ❑ Will Call
���� You must call the inspector when readyl Date Ready.
I certiy that I am the ❑�CENSED CON7RACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
�ns�rt�cnowa vn ewcK oF reLLOw coPV BOARD OF ELECTRICITV COPV EB-00001Mt4 8.1. 2002