P - 79168REQUEST FOR ELECTRICAL INSPECTION
•-� ����_ 9 6 9�g Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800-627-3529 www.electricity.state.mn.us "
NEW ❑ REMODEL ❑ ADDITION q REPAIR Describe -using the back of the white copy if necessary - the work covered by ihis request:
XCEL ENERGY SAVER'S SWITCH
GENERAL FEES Outdoor L' hti Standard $1
SERVICES I POWER SUPPLIES Tr�c Signal Standard @$5 _
CIRCUITS / FEEDERS
0 to 200 Ampere p$5
Above 200 Ampere (�a.$10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE �ENERAL
MULTIFAMILY DWELLINGS PER UNIT
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
Boom
I ISII II III II III II III I��I II III II �I II NI ��I I��
�,7579699
Transformers over 10 KVA $ 20
Transformer I Power Supply for Signs I Oudine Lighting @$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two InspecGon Trips Each Dwelling Unit �$80
Addi6onal Inspection Trips . $20
Investiqative Fee
TOTAL FEE
(minimum total fee is $20) 20.50
THISAKEAF INSPECiORL5EQ`lv
I hereby certify Mat I inspected tl�e electrical installation described herein on the dates staled:
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nequesc uaie: Rough-i� Inspection Required? LJ Yes C? No InSpeGion Othw Than Rough-In: �Ready NaYv ❑ V1rll Call
� i%i ���i You must call the inspectw when ready! Date Ready.
I certify that I am tl�e ;KI LICENSED CONTRACTOR ❑COMPANY ❑ ONMER and hereby request inspection of the elechical work at:
IN87RUCTONB ON BACK OF YELLOW CqW BOARD OF ELECTRICITY CAPV E&00007A-74 8.1. 2002