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P - 79774, REQUEST FOR ELECTRICAL INSPECTION Minnesota Board of Electricity 1-396-541 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 ` (651) 642-0800 TTY/MRS 1-800-627-3529 www. electricity. sta ie. mn. us Identify the work covered by this request: �; XCEL ENER43Y SRVER'S SWITC:Fi ❑ IVEW O REMODEL ❑ ADDITION ❑ REPAIR 0 to 400 Ai 401 to 800 0 GENERAL FEES Above 200 Ampere � $10 A�4RM, COMMUNICATION, REMOTE CONTROL CIFiCUITS. CIRCUITS OF LESS THAN 50 VOLTS Each System Device or Apparatus �$.50 ADDITIONS TO THE GENERAL MULTIFAMILY DWELLINGS (PER UNI� �I 3 to 12 Units �$50 Per Unit Retrofit � $25 uer Fixture Transformers u to 10 KVA �$10 Transfortners over 10 KVA � $20 � Transfortners / Powe� Supply for Signs / Outline Lighting � ONE & TWO FAMILY DWELLINGS, EACH UNIT Includes the Service and/or Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unit �$E Additional Inspection Trips � $20 FOR INSPECTOF USE ONLY ,<!�> �.z� � , >_�� .;;::�:-.,.... TOTAL FEE total fee is $20} D$25 I hereby certify ihet I inapectetl Me electrical installatbn tlescribetl herein on ihe tlates 8letetl: (� � � ROUGN IN DATE � 7Uf FlW1L INSPECTIIXJ �7 OHTE lile �`'—�'"''�' J ' T� 7 ^ ° � = . — — — — �F�+� _ rv�n � n�vnv_icl�SbUYJ�Y,�LJ]l��a. � ��l �r � _ mr � �_ �� � � n � — —� � — � FOR OFFICE USE ONLY IINIIIIIIIIII�IIINIIIIIIIINIIININII I � � IIIII�I ti *1 396541 3* ��'�� Reque Rough-in Inspection Required? ❑ Yes No Inspection Other Than Rough-in: Ready Now ❑ Will Call You must call the inspectar when ready! Date Ready I certify that i am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at: ovMr+u ur t�tG i ttiGiTY COPY INSTRUCTIONS ON BACK OF YELLOW COPY