P - 77033—o REQUEST FOR ELECTRICA INSP CTION R`
� 1 �O 3 � �o � � 9 � Minnesota Board of Electricity ��Q� ��/n�� �-- ;�,
1821 University Avenue Suite S-128, Sa nt �aul, Minneso a 5'�f4
�#b8II9 (651)642-0800TTY/MRS 1-800-627-3529 www.electricity.state.mn.us �;�
Describe -using the back of the white copy if necessary - the work covered by this request:
Repazr st:orm damaged service entrance mast
GENERAL FEES Outdoor Liahtino Standard (� $1
Above 800 Am ere a$75
CIRCUITS I FEEDERS
0 to 200 Am ere $5
Above 200 Am re $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A ratus @$.50
ADDITIONS TO THE GENERAL FEES
Traffic Signal Standard
Supplemental Fee @
Transformers up to 10 I
Transformers over 10 h
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
AddRional Inspection Trips @ $20
1 Investigative Fee ll r C a r Q e
Reinsaection Fee an $20
- - ------ .-. ._.._.--
3 to 12 Units @$50 Per Unit (minimum total fee is $20) $ 3 0.� 0
Each Additional Unit @$25 THis naen Foa iHSaECTOR use oNir
OTHER ADDITIONAL FEES
Lightin RBtfOflt $.25 f FiXtu�e I hereby certify that I inspecled the electrical installation described herein on the dates staled:
Center Pivot Irti ation Boom $40 ROUGH IN oATe
Manufactured Home Park Lots $25
Recreational Vehicle Park Sites $5 F�w,��NS�cnoN on.E
Se arate Bondin Ins ion $20 �"--�
Special Inspection $30 r Hour E%PoREDI ' OATE
Special Ins ion $.31 r Mile
5 INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
_,, .
I I�II IIII� IIIII IIIII (Ilil IIIII IIIII II I�) �� I�I
18391896
Date: Rou h-in Ins ction Re uired? ❑Yes
g pe q � No Inspection Other Than Rough-In: � Ready Now � Will Cail
��� 2� � �� you must call the inspector when ready! Date Ready: 1(� � 2��(� �j
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecUical work at
Job Site Street Address ��y
6321-7th St NE Fridle
Township Section Range Fire No. County
Anoka
Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
Jim McGregor (76� 571-3987 ( �
Electrical Utility Electrical Utility Address
Xcel Energy Mpls
ConVactor! Company Name Contractor License Number
Heights F.lectri.c, Inc. CA000827
Mailing Address (Contractor, C tion)
704 - 40th Ave NE Columbia Heights, MN SS421
AWhoraed Signature (Con�or 'on) Please Provide
� 76.� 7 8
INSTRIICTI[]NS f]N NA/'K nF VFI 1!1W (:(lOV wneon n� c� c�TOit�iTV t�nov
Master Electrician or
License Number
8888 � �