P - 79171� _
' REQUEST FOR ELECTRICAL INSPECTION '
� � � � '] � [] � � � Minnesota Board of Electricity -
� �� 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
NEW O REMODEL O ADDITION ❑ REPAIR Describe -usin�q the back ot the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVER S SWITCH
GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Trafic Sianal Standard (�a $5
0 to 400 Ai
401 to 800
0 to 200 Am e$5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUiTS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus l� $.50
� II�I �I II� I� I(! �I �II II I�I I� � II II� I� I�1 �� I� I�
1,7579723
to 10 KVA @ $10
�r10KVA(�$20
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 �1$80
TOTAL FEE
(minimum total fee is $20) 20.50
iw5 AREA FIXt INSPECLOR USE pJIY
I hereby certify that I inspected the electicat installation described herein on tlie dates si�ed:
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ReQuest Date: Rough�n Inspedion Required? O Yes No Inspedion Other Than Rough-In: I7Ready Now ❑ Will Call
� i1i ���i You must call the inspeclor when ready! Date Ready:
I ceRify fhat I am the XI LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
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