P - 78109C�j(] � REQUEST FOR ELECTRICAL INSPECTION
1� J J J- 0 4 4 3 Minnesota Board of ElecVicity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
W❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the wak covered by this request:
SERVICES I POWER SUPPLIES
0 to 400 Am ere $25
401 to 600 Am ere b50
Atwve 800 Am re S75
CIRCUITS I FEEDERS
0 to 200 Ampere @ $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS Of LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL I
MULTIFAMILY DWELLINGS PER UNI�
3 to 12 Units @ E50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
htin Rehofit $.25 er Fixture
CeMer Pivot Irti ation Boom 340
Manufaclured Home Park LoYs E25
Recreational Vehide Park Sites $5
arate Bondin Ins tion $20
Soeciai InsoecGan � S30 oer Hour
Standard
Transfortners u to 10 KVA $10
Transfortners over 10 KVA @$ 20
Transformer I Power SupD�Y for Signs / OuUine Lightinq_ �$5
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$BO
Additional Ins ection Tri s $20
Investigative fee
Reinsoection Fee an 820
TOTAL FEE I
(minimum total fee is $20) �D� ` �
iN15 MEA Fqt H15PECid2 USE plY
I hereby cer6y that I inspected the electrical instalt�on bed herein on the da0es stated:
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� THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHII
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Requesl Date: Rough�n Inspection Required? Yes ❑ No Irupedion O[her Th� RougMn: ❑Ready Now Will Call
1 1—�' Q�} You must call the inspector when ready! Date Ready:
I certify that I am ihe �ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elactrical work at:
Job Site Address (Street, Box, or Route No.) City Zip Code
3022 Ashton Ave. Fridley 55432
Todd Marchiafava
Anoka
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Xcel
:antractor / Company Name Conffactor License Number Master EJeetrician or Power Limited Technician
Bassing Electric CA0436�+ `'ce"�""'"�`
Nailing Address (Contrada, Company a Owner Per/orming Installation)
135�+ i�IcKay Drive NE, IIam Lake, MN 553Q4
4uthorized ' ture Contre or, Compan or Owner Perfortning Installation) Phone (s)
703-/�34-3298
BTRUC710NS ON BACK OF VELLOW CO BOARD OF ELECTRICITY COPV EB-00001M74 8.1. 2(102