P - 79184" REQUEST FOR ELECTRICAL INSPECTION
�--� "') � 7 �(] Q C, � Minnesota Board of Electricity -
( � .J V�J 1g21 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-G27-3529 www.electriciry.state.mn.us
NEW 0 REMODEL ❑ ADDITION 0 REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVER'S SWITCH
�ENERAL FEES Outdoor L' h6n Siandard $7
SERVICES 1 POWER SUPPLIES Traffic Si nal Standard $5
0 to 4D0 Amoere fd S25 Suoolemental Fee (�a $20
401 to 800
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNAL�NG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Dev'�ce a Ap�aratus �$.50
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
!�II h hi II II� II Ili il � il ill li III II I II II I� I I�i!
],7579$S5
0
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
CircuiGs and Two Inspection Trips EaCh Dwelling Unit �$80
(minimum total fee is $20) � 2D.50
TMIS MEA FOR INSPECTOR USE pLY
I hereby certify thffi I inspected tlie eiectrical install�ion tlescribed heiein on the da0es sG�d:
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rt��� ��e� Rough-in Inspection Required? ❑ Yes ❑ No Inspedion Oth� Than Rough-In: Ready Now � Wdl Catl
� 1%1 �Q� You must cati the inspector when ready! Date Ready:
I certify that I am the �] LICENSED CONTRACTOR 0 COMPANY ❑ OWNER and hereby iequest inspection of the e�ectrical work at::
�nsrwucnpws ON BpCK OF YELLOW COPY BOARD OF ELECTRICITV CAPV EB-0OOO1M74 8.1. 2002