P - 79315> ❑ REQUEST FOR ELECTRICAL INSPECTION
�` � Z Z���� p p Minnesota Board of Electricity
p 0 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �i
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electnc�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 EhJERGY SAVER'S SWlTC�i
GENERAI FEES Outdoor Li htin Standard $t
SERVICES I POWER SUPPIIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to SIXl Am re $50 Transformers u to 10 KVA $10
Above 800 Am re $75 Transformers over 10 KVA $ 20
CIRCUITS I FEEDERS Transfortner / Paxer Su I for Si ns I OuUine Li htin $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Senice andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Inspec6on Trips �$20
3 to 12 Units @ $50
Exh AddiGonal Unit
Center Pivot
Hour
Mile
I ��H il � II III II I� II I� � I I I II �I II HI II IH I I�I
�,7735788
Reins ction Fee $20
TOTAL FEE
(minimum total fee is $20) $24.50
TMS MEA Fqt IISPECiOR USE OfiY
I hereby cer6ry that I inspected the ekctrical insfalla6on described I�rein on the da�es sta0ed:
� �ayg.
DATE
OMPLETED WiTHIN 12 MONTHS
�5a��
a0 - S` C�
Request Date: Rough�n Inspection Required? ❑ Yes Inspedion Other Than Rough-In: ❑ ady Now ❑ Wdl Cell
O�IZO/O�i You must call the inspecta when ready! Date Ready:
I certify that I am the �(ICENSED CONTRACTOR OCOMPANY ❑ OWNER and hereby request inspection of the electripl work at:
INSTRUCTON9 ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPY E8-00001M14 8.1. 2002