P - 79221REQUEST FOR ELECTRICAL INSPECTION
,�� Z� Q� C, /� �� Minnesota Board of Electricity
v .J `t �g2� University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYIMRS 7-800-627-3529 www.electriciry.state.mn.us
:W O REMODEL ❑ ADDITION ❑ REPAIR Describe -usin the back of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVE�'S SWITCH
GENERAL FEES Outdoor Li htin Siandard $t
✓ICES I POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Amcere Cd $50 Transformers uD to 10 KVA p$10
CIRCUITS OF LESS THAN 50 VOLTS
Center Pivot
Recreational
Mile
illl II I� II � II �II II IH II III � I� II III II �I I I�I
1�7685470
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Txro Inspec6on Trips Each Dwelling Unit @$80
Additional Insoection Tnps p $20
Investi ative Fee
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20) 20,50
THIS MEA FOR INSPELTpi USE 01�1v
I hereby certify Mat I inspected the electrical instadafion descnbed heran on tlie dates stffied:
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Request Date: Raigh�n I�spection Requiredl ❑ Yes ❑ TJo IrspeGion Other Than Rough-In: ❑Ready Now 0 NNII Call
�7�� You must call the inspecta when readyl Date Ready.
I certify that I am the ❑�ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at:
Job Site Address (Street, Box a Route No.) City Zip Code
A�1 63RD AVE NE FRIDLEY 65432
Section Township � i� No. County �O�
Owner/Ocwpant Name Poease Provide Two (2) Phone Number(s) Including Area Code
MlLLER DAVID ( ) ( �
Power Supplier Power Suppli� Address
XCEL ENER�Y
Contracta / Company Name ConVacta License Number Master Electrician or Pow� Limited Technid�
HUhIT ELECTRIG CORPORATION CA 00888 ucense Num�
Mailing Address (Contraclor, Company or Own� Performing Installation)
2300 TERRITQRIAL ROAD , SAtNT PAUL, MN 55114
Author¢ed �gneture (Contractw, Company a Owner Perfortning Installation) Phone (s)
(��'i�'� 651 646-2911
IN6TRUCTON8 ON BACK OF VELLOW COPY BOARD OF ELECTRICT' CAPV E&00007A-74 8.1. 2002