P - 79167� REQUEST FOR ELECTRICAL INSPECTION � �
-�, ��• �4 � 1_ 9 6 g� Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, 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 �ecessary - the vrork covered by this request:
XCEL ENERGY SAVER'S SWITGH
soo
o ro 200
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
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1,7579681
ONE & TWO FAMILY DWELL{NGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � 20.50
TH�S PREA FOR iIAPECTOR USE ONLr
I herebY certry that I inspec�d the electrical install�on described herein on tlie dates slated:
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Request Oate: Rough-in Inspection Required? ❑ Ves L�No Inspedion Other Than Rough-In: L'lkeady t�bw 0 VY�U Ca�l
�iii ���i You must call ihe inspector when ready! Date Ready:
I certity that I am the �I LICENSED CONTRACTOR ❑ COMPANY C7 OWNER and hereby request inspection of the elec6ical work at:
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