P - 79300REQUEST FOR ELECTRICAL INSPECTION
� � � � � � [ � � � Minnesota Board of Electricity -
J 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
, (651) 642-0800 TTY/MRS 1-800-627-3529 www.e[ectriciry.state.mn.us
� NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL E�IERGY SAVER'S S'WITCH
GENERAL FEES Outdoor Li htin Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
401 to 800 Amoere (a� S50 Transformers uo to 10 KVA an $10
Above B00 Amper
;UITS / FEEDERS
0 to 200 Amcere G
AIARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus $.50
ADDITIONS TO THE GENERAL FEES
� ��N ��� �� �� �� ��� �� ��� H ��� �� �� �� �� �� ��) � ��
1 7 7 3 5 5? 2
Transformers over 10 KVA $ 20
Transformer / Power Supply for Signs / OuUine Lighting @$5
ONE & 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
TOTALFEE
(minimum total fee is $20) $20.5D
THIS AREA FOR MLSPECiqi USE Qlv
I hereby certiry that I inspected the electrical insfallation described herein on the d�es sfaled:
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neques[ ua[e: Rough-in Inspection Required? LJ Yes LYNo Inspec[ion Other Than Rough-In: LJl�ady Now IJ Will Call
Q9%20�QQ You must call the inspectw when ready! Date Ready:
I certify that I am the �ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Address (Street, Box, a Raute No.) City Zip Code
6354 ARTHUR ST NE FRIDLEY 55432
Section Township Range Fire No. County
J�I�O�
OwnedOxupant Name n + Please Provide Two (2) Phone Number(s) Induding Area Code
NIKOLOV ROSSEN � � tJ � ( � � �
Power Supplier Power Supplier Address
XCEL ENERc3Y
Contractor / Company Name ConVactor License Number Master Electridan a Power Limited Technician
HUNT ELECTRIC CORPt7RATfON CA 0�883 u�� r�meer
Mailing Address (Contractor, Company or Owner Performing Installation)
2300 TERRITbRIAL I�OAd , SAINT PAUL, MN 55114
Authorized Signalure (CoMractor, Company or Owner Perfortning Installation) Phone (s)
'�'� 651 6�6-29i 1
INSTRUC710N8 ON BACK OF YELLOW COPY BOARD OF ELEC1F21CT' CAPV E&0OOO7M14 8.7. 2002