P - 79170� REQUEST FOR ELECTRICAL INSPECTION
�� r f� 1- 9 71 ❑ 8121 Un��versBy Aven� eESu te S- 28, Saint Paul, Minnesota 55104 -
(651) 642-0800 TTY/MRS 1-800-6273529 www.electricity.state.mn.us
NEW Q REMODEL ❑ ADDITION D REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVER'S SWITCH
GENERAL FEES Outdoor Li h6n Sianda�d $1
SERVICES / POWER SUPPLIES Trafic Si �al Standard $5
0 to 400 Amcere C�a. $25 Supplemental Fee �a $20
ALARM, COMMUNICAT�ON, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL
Retrofit
Boom
I IHI II I� fI Hl II If{ II III ��1I II 111 II I� il HI I li�
J,7579715
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Supply for Sipns I Outline Ligh6ng @$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
Investi ative Fee
Reins tion Fee $20
TOTAL FEE
(minimum total fee is $20) 2�.50
iH15 AREA FOR INfiPECiOR USE OKY
I hereby certify that I inspected the elecOrical installa6on described herein on tlie dafes sta�d:
,e � � �
ii 3375
o�•SCU
Request Date: Rough�n Inspection Required? ❑ Yes C']'NO Inspection Other Than Rough-In: C7Reedy Now Cl VYdI Call
�i%1 ���i Vou must call the inspector when ready! Date Ready:
I certify that I am ihe $I UCENSED CONTRACTOR � COMPANY ❑ OWNER and hereby request inspecfion of tt�e elecUical work at:
INSTRUCTONS ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPY EB-00001M74 8.1. 2002