P - 79345REQUEST FOR ELECTRICAL WSPECTION
�` 1 /�- 613 3❑ ��nnesota Board of Electricity �
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 T'fY/MRS 1-800-627-3529 www.electriciry.state.mn.us
NEW 0 REMODEL ❑ ADDITION 0 REPAIR Describe -using the back of ihe white copy if necessary - the work covered by this request:
XCEL ENER�Y SAVER'S SWI'"CH
GENERAL FEES Ouidoor Li htin Standard $t
SERVICES / POWER SUPPLIES Tr�c Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Amcere (a� $50 Transformers uD to 10 KVA (� $10
CIRCUITS OF LESS THAN 50 VOLTS
Addifional
Lighling Retrofit @ $.25 per
Center Pivot Irriaation Boom
I iiN � ill � I� I{ �I II III i�lll ll 11l II �l II III I I�I
1 7 7 3 6 1� 3
� Transformer / Power SupDly for Sians / Outline Ligh6ng p$5
ONE 8 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
TOTALFEE
(minimum total fee is $20) $20.50
iH15 ARFA FOR INSPECiqi USE OIIY
I heteby certiry that 1 inspec�E the electric� insWlagon desCribed herein on tlm dates Statl.W:
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Request Date: Rough-in Inspection Required? ❑ Yes ❑ Inspettion Other Than Raigh-In: ❑k�ady Now ❑ Wfll Call
��'1�%�Q Vou must call the inspeclor when ready! Date Ready.
I certify that I am the ❑�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
INBTRUCTONB ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPV � . �e""r^+'^"' °�'� "^'�