P - 79185- REQUEST FOR ELECTRICAL WSPECTION -� �
�� f J 1- 9 8 6❑3 Minnesota Board of Electricity -
1821 University Avenue Suite 5-128, Sa+nt Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-G27-3529 www.electricity.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -usiag the back of the white copy if �ecessary - the wo�k covered by this request:
XCEL ENERGY SAVER'S SWITCH
GENERAL FEES Outdoor Li hfia Standard $1
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERA�
Center Pivot Irriqation Boom
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1,7579863
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 @$80
Fee
(minimum total fee is $20) � 20.�v0
iH15 AREA FIXt INSPECiOR USE ONLY
I hereby cer6ty that I inspecOed the electrical installa6on described herein on the dates sta�d:
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Request Date: Rough-in InspecUon Required? ❑ Yes �T No Inspedion Other Than RougMn: C7Ready Now ❑ VWII Call
� Q� �1 ��� You must call the inspector when ready! Date Ready:
I certi(y fhat I am �e �I LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecVical work at::
INETRUCTONE ON BACK OF YELLOW GOPY BOARD OF ELEC7RICITV COPV E&OOOOtM14 e.t. 20�