P - 79446REQUEST FOR ELECTRICAL INSPECTION
�I � � � � ^ _ Minnesota Board of ElectriciTy
� 1 � y 1821 University Avenue Suite 5-128, Saint Paul, Minnesoia 55104
" � (651) 642-0800 TTY/MRS 7-800-627-3529 .�
' www.electricity.stade.mn.us
FEMODEL ❑ADDITION ❑FEPAIR
CIFCUITS OF LE55 THAN 50
Indudes ihe Sernce arMlor Prnver Supply up to 500 Amperes, All 75.5
Circuits and Two Inspeclion Trips Each Dwelling Unit �$80
Addi6onal Ins edbn Tn � $20
inaesti ative Fee
Reins tlon Fee � $20
TOTAL FEE �5.5
(minimum tota� fee is $20)
�A iwsomw use ax.
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hcveby ceNty lhat I insp¢clea tM el ��al ins�ella�ion descnbed herein on ��e detes sWtee:
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I�III�II��II (I��I III�) �IIII I�II�IIIIII�IIIIIII I��I Fdi OFFlCE USE ONLY
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y��-��� ���ayecnon naqwreor � res U rvo I Inspeclron Olher Than Rough-In: ❑ Reatly Now Will Call
I Y11-20-01-� � Vou must call ihe inspector when reatly� D te q atly
I ce�ify ihat I am the �f LICENSED COMRACTOR ❑ COMPANY ❑ OWNER and hereby reques[ inspedion ot ihe electrical work at:
.bb Atltlress (Street, Box, or RoWe No.) Ciry Zip Cotle
7492 Bacon Drive Frid7av
I BL1C�T COI1StL'UCt].OTl
Phone
MVnvi �C�S� S �
Xcel Energy
Elecvicel Contrec[or / Company Name Cortlracfor License Number
L3ZPS $12CtY'1C� II1C. C'j;pj j j �
Mailing Atldress (COMrado Compairy or Owner Pertorming Instellation)
8764 Arth treet NE,, Spring Lalce park, MN 55432
AuHrorizetl SgnaW Co doq Company or p,yner�aMO}ming Ins�allation) Phone
784-3729
EB-00001A-13