P - 79349❑ REQUEST FOR ELECTRICAL INSPECTION
�k � 1 1�- 618 2 8121 UnrversBy AvenueESu terS- 28, Saint Paul, Minnesota 55104
. (651) 642-0800 TfY/MRS 1-800-627-3529 www.electrec�ty.state.mn.us
NEW O REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVER'S SWfTCH
GENERAL FEES Outdoor Liahtinq Standard (al $t _
SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
E�h System Device or Apparffius @$.50
ADDITIONS TO THE GENERAL F
3 to 12 Units @$50 Per
Each Additional Unit @:
Retrofit
I i�{I II I� II �I 8 IN I{ Ilf H{I I II �I II 11I {{ I� I�{
17736182
Standard
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection 7rips Each Dwelling Unit @$60
Fee
TOTAL FEE
(minimum total fee is $20) $a0.50
iH15 MFA FOR INSPECiOR USE MY
I hereby cer6fy that 1 inspected the electrical instaYation described herein on tl�e dates sta�d:
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Request Dffie: Rough-in Inspection Required? ❑ Yes ❑�No Inspection Other Than Rough-In: ORbady Now ❑ VIlII Call
�Qj'Z(,�fOQ You must call the inspector when ready! Date Ready:
I certiiy that I am the CDCICENSED COAITRACTOR ❑COMPANY ❑ OWNER and hereby request inspection oi the electrical work at:
INSTRUCTION6 ON BACK OF YELLOW GOPY BOARD OF ELECTRICITV COPV EB•0OOO1M11 8.7. 2002