P - 79276❑ REQUEST FOR ELECTRICAL INSPECTION
�+ 1��- 5 2 3 �F Minnesota Board of Electricity
1821 Univessity Avenue Suite S-128, Saint Pauf. Minnesota 55104
(651) 642-0800 TlYlMRS 1-800-627-3529 www.electriciry.state.mn.tu
fl NEW ❑ REMODEL O ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL ENERGY �AVER'� SW�!?'�i-!
401 to BOD
Above 800
CIRCUITS OF LESS THAN 50 VOLTS
3 to 72 Units @$50 Per Unit
Each Additional Unit Qa $25
Boom
11�1111 �� Ill II Ill II I� � II! If �ll 11 �1 II �! 1 lii)
L 7 7 3 5 2 3 4
Fee
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andior Power Supply up to 500 Amperes, All
Circuits and Tvro Inspection Trips Each Daelfing Unit @$80
Reins cGon Fee $20
TOTAL FEE
(minimum total fee is $20) $2�,50
iH15 AREA FOR INSPECiOR USE Mr
I hereby certry mat I inspected tl�e efectrical inst�lalion described herein on the dates stated:
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Request Date: Rough-in Inspection Required? ❑ Yes OTb Inspection Oth� Than Rough-In: ORbady Now LJ V1rll Call
(JJ�OJ� You must call the inspecta when ready! Date Ready.
I certity that I am the [�ICENSED CONTRACTOR ❑ COMAANY ❑ 01NNER ar�d hereby request inspection of tl�e electrical work at:
INBTRUCTONS ON BACK OF YELLOW COPY 9DARD OF ELECTRICITY CAPY EB-0OOOtA-74 e.t. 2ovt