P - 79330REQUEST FOR ELECTRICAL INSPECTION
�'� � � � � � (� � � Minnesota Board of Electricity -
J 1821 University Avenue Suite S-128, Saint Paul, Mi�nesota 55t04
. (651) 642-0800 TTY/MRS t-800-627-3529 www.electricity.state.mn.us
l� NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the woric covered by this request:
XCEL ENERGY SAVER`� S'V�iiTCH
GENERAL FEES Outdoor Liqhtinq S;andard an. $1
0
CIRCUITS OF LESS THAN 50 VOLTS
Standard
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Grcuits and Two Inspection Trips Each Dwelling Unit @$60
3 to 12 Units �$50 Per Unit (minimum total fee is $20) � �20.5�
E2Ch Additionel Unit @$25 rws na�, roa iwsaEC.oa use orxr
I hereby ceAify that I inspected the electrical installation described herein on the dates staMd:
+ �/'.Z.G
I I N{i1��NEll��ll�fl�l� n5a7/
II�iIN1�8N11(i IIIN�
177354'78
a� -s�
Request Date: Rough-i� Inspaction Required? ❑ Yes d'No Inspedion Other Than Rough-In: OReady Now � Will Call
4C�("��(� You must calt the inspeclor when ready! Date Ready:
I certiiy that I am 1he C�¢ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspec6on of tlie electrical work at::
MSTRUC710N8 ON BACK OF YELLOW GOPY BOARD OF EI�ECTRICITY COPY E&OOOD1M71 8.1. 2004