P - 79289❑ REQUEST FOR ELECTRICAL INSPECTION
� � —{� � � � 3 � 2 Minnesota Board of Electricity -
( 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
' (651) 642-0800 TTYIMRS 1-800-627-3529 www.electric:ty.state.mn.us
NEW C] REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL Et+1ERGY SAVER`5 SENITCH
GENERAL FEES Outdoor Li htin S!andard $t
SERVICE5/ POWER SUPPLIES Traffic Sianal Standard (a� $5
40110 800
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUfTS OF LESS THAN 50 VOLTS
ADDITIONS TO THE GENERAL FEES
MILY DWELLINGS (PER UNIT�
12 Units Cc� $50 Per Unit
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ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senice andlor Power Suppiy up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � $20.50
rHis u�� Fors nsaecroR usE or�xr
I hereby cerby that 1 inspected the electrical insfsdla6on described herein on the da�es siated:
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Request Date: Rough-in Inspection Required? ❑ Yes O�o InSp�tion Olher Than Rough-in: ❑it�ady Now CJ WHI Call
Q�Qj[pQ You must call the inspedw when ready! Date Ready:
I certify that I am the �CICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ttie elesUicai work ax:
iNSntucnoNS oN e�cK oF rEU.ow corr eonrto oF e�ctrticm coPr =_-,�• ��- �• �. �•....•