P - 79281REQUEST FOR ELECTRICAL INSPECTION
�� 1 1�- 5 2 9 1❑ Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651)642-0800TlY/MRS 1-800-627-3529 www.eleciricity.siate.mn.us
fl NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAV�R'S SWfTGH
GENERAL FEES Outdoor Li h6n Standard $1
SERVICES / POWER SUPPLIES Traffic Sipnal Standard @$5
ALARM,
CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL
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1,7735291
Transformers u to 10 KVA $10
Transformers over 10 KVA .$ 20
Transformer I Power Suppty for Signs I Outline Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up l0 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$8(1
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20) $20,50
THIS MEA:OR RJSPECTCR USE 0I1V
I hereby cerUty that I inspected the electrical instaila6on described herein on tlie dates sta0zd:
27—�
�NNECTED IF NOT COMPLETED WITHIN 72 MONTFIS _(
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Request Date: Rough�n Inspection Required7 ❑ Yes ❑�Fb Inspedion Other Than Rough-In: ❑I�ady Now ❑ Will Call
��f2Qf � You must call the inspector when ready! Date Ready:
I certify that I am the �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
IN8IRUCTONS ON BAGK OF VELLOW COPY BOARD OF ELECTRICITV CAPV EB-OOOOtA-14 8.1. 20D2