P - 79331' REQUEST FOR ELECTRICAL INSPECTION
� � � � � � � � � � Minnesota Board of Efectricity �
1821 University Avenue Suite S-128, Sai�t Paui, Minnesota 55104
- (651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
] REMODEL ❑ ADDITION ❑ REPAIR Describe -using the b�k of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVER'S SIMTCH
GENERAL FEES Outdoor Li htin Standard $1
I POWER SUPPLIES Traffic Si nal Standard $5
b Am re $25 Su lemental Fee $20
ann am��P n ssn Transformers uo to 10 KVA (� $10
� Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL F
MUCTIFAMILY DWELLINGS PER UNIT
3 to l2 Units @$50 Per Unit
Each Additional Unit @ $25
I�H INII IFill N�I II {11 N1N 11�11 II�HI II fll i INl
1 7� 3 5 9 a 6
7ransformers over iu KvA a7 b[u
Transformer I Power Supply for Siqns / Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$60
(minimum total fee +s $20) � ��a �'��
THIS AREA FOR INSPECiOR 115E OInV
I hereby cer6ry Mat I inspected the elecCical insfaNation Oescnbed herein on the dates sfaOed:
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�2 sa�/
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rcequest ua[e: Rough-in Inspection Required? 0 Yes ❑�lo Inspection Other Than Rough-In: ❑Raady Now 0 Will Call
�9i��i�i You must call the inspector when ready! Date Ready:
I certify that I am ihe �CICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
IN8TRUC710N8 ON BACK OF VELLOW COPY BOARD OF ELEC7RICITV CAPY . E8-00001A-14 8.1. 2002