P - 79283� REQUEST FOR ELECTRICAL INSPECTION
�����- 5 31 Minnesota Board of Electricity -
;y � 1821 University Avenue Suite S-128, Saint Paui, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVER'S SWITGH
GENERAL FEES Outdoor Li htin Slandard $1
RVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re L25 Su lemental Fee $20
401 to BIXl Amcere � S5D Transfortners u� to 10 KVA Ca? $10
CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELLINGS PEI
3 to 12 Units �$50 Per Unit
Each Additional Unit @ $25
Hour
` I I
I I�II I{� II I� I) I� II III � III II III II �I II � I I�
1 7 7 3 5 3� 7
Transformers over 10 KVA $ 20
Transfortner / Power Supply for Signs I Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$SO
(minimum total fee is $20) � $20,50
THIS �REA FOR NEPECiOR USE IXYv
I hereby cer6fy that 1 inspected tbe electrical instaqatlon described haein on the dartes shaled:
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IOT COMPLETED WITHIN 12 MONTHS
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Request Date: Roughin Inspection Required? ❑ Yes Inspedion Other Than Rough-In: ❑�%ady Now ❑ VYII Call
pgJ�p�q You must call the inspector when ready! Date Ready.
I certiry lhat I am the C3�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of fhe electrical work at::
INSTRUCTWIB ON BACK OF YELLOW GOPY BOARD OF ELECTRIGTY COPY �� ��- �� �� ����