P - 79316❑ REQUEST FOR ELECTRiCAL INSPECTION
�����_ 5 7 g C Minnesota Board of Electncity � s
V 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800-627-3529 www.electricity.state.mn.us
L5 NEW O REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL Eh1ERGY SAVER'S SWITCH
0 to 40D
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
Each
Center Pivot
Traffic Siqnal Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Incfudes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � $30,50
iM15 ARFA FIXt INSPECi0RU5E 0llY
I hereby cerGfy that I inspected the electric� installa6on described herein on tlie dates staDed:
�— Fd'� U�I
$pgr.ial In�nPr.tion GD $ 31 pE! Mile � �
IIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Request Dale: Rough-in Inspection Required? ❑ Yes �FIO Inspection Other Than RougM�: �RCedy N�v l7 WiU Call
[j�'�(f j�4 You must call the inspecta wFien ready! Date Ready.
I certity that I am the C�ICENSED CONTRACTOR ❑ COMPANY ❑ O4VNER arni hereby request inspection of ihe electrical work at•:
INSTRUCTONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY ttl'uu'ui^"" °�'' """