P - 79313❑ REQUEST FOR ELECTRICAL INSPECTION
���� �- 5 7 6 2 Minnesota Board of Electricity -
1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
' (651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us "
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XGEL ENERGY SAVER'S SWIT�H
GENERAL FEES Outdoor Li htin S!andard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to dOD Amcere (al L25 Supplemental Fee @$20
0 to 200 Am re $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Center Pivot Imaafion Boom
II����IIII�IIII�IIIII�IIIII�III ��I��
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177357�2
ONE 8 TWO FAMILY DWELLINGS, EACH UNI I
Includes lhe Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
TOTAL FEE
(minimum total fee is $20) $20,50
THIS AREA Fqi 1lLSPECTOR USE ONLY
I hereby certiry thal l inspected the electrital installation described I�erein on the dates st�ed:
� S� % /
�-S U
I'---" —'°' Rough-in Inspection Required? ❑ Ves Inspection Other Than Rough-In: ady Now ❑ N411 Call
���� You must call the inspector when reedy� Date Read
Y
� cerbfy that 1 am the C�(.�CENSED CONTRACTOR 0 COMPANY � OWNER and hereb
Job Site Address (S�et_ pnr ,,, o�,.e .,_ , Y�Q�st inspection of the electrical work at::
5821 ARTHUR ST NE
FRIDLEY $��2
Counry
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MOOF2E dONqLd L � . ,,,. • (r
�ver Supplier � � \ �
Powerr �
XGEL ENEF�c�Y
Mredor / Canpany Name
Hun�-r e�e-r��e eoR�t�t�-norv �«,V�`°• �`�,� N�m
ing Address (ConVector� Company a Owner Performing Installation) �•l� ��6��
2300 TERRITORIAL Rpqp , gq�IVT pqUL, MN 531 i4
�M,� �:.....,..._ ,,.__. . _
IN87RUC710NS ON BACK OF YELLOW Cppy
BDARD OF ELECTRICRV CppY
� �
e� crecmqan or
License Number
�41 £��-?91 �
E&OOOp1A-14 . 8.1. 2002