P - 79781+ REQUEST FOR ELtCTRICAL INSPECTION
Minnesota Board of Electricity °
, 1-396-553 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 '- `
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn. us
Identity the work covered by this request:
U REW ❑ REMODEL ❑ ADDITION ❑ REPAIR
401 to
0 to 200 Am ere �$5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
TIFAMILY
3to12Ui
U�It � �'
OTHER
� $.31 oer Mile
XCEL ENEROY SAVER'S SWITCH
Outdoor Lighting Standard � $1
TraHic Siqnal Standard � $5
Transformers / Power Su I for Si ns / Outline Li htin �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service and/or Power Supply up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Dwelling Unit �$f
Additional Inspectlon Trips � $20
Fee �
f-0fl INSPECTOfl USE
FEE
I hereby certNy that I inspected ihe eleclricel installation described herein on ihe tlates statetl:
ROUGHIN DATE
Fl W1L INSVECTIIXJ DATE
� Q- :�. � `°3
— -- — _�'--- — — — = � = _ = — — — s ��- --- — — — — — —
FOR OFFICE USE ONLY
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Reques) ��ro'� Rough-in Inspection Required? ❑ Yes (�No Inspeciion Other Than Rough-in: �Ready Now ❑ Will Call
You must call the inspector when ready! Date Ready:
I certi(y that I am the f� LICENSED CONTRACTOR ❑ GOMPANY ❑ OWNER and hereby request inspection of the eleefical work at:
Job Addres�9c, so�S�G CURYE c'� FRIULEY z�p coaa
Section Township Range Rre No. County
occu�E(�� ��F�Y.� 3 O O(� �� Phone
Power S�DDIIBr �Y Address
XC�L
ElectricaJ �qpt�G(p6/S�W,pp��y1J3Q�,.,,.,,.,�,rl� Contractor LicgQ,�e �� Master License Number
MVP! I tL.ttr I KI(i trVfSnJ LA
Mai�in9 q�s �c��n�� � P�r�g��t�l �o�N 55114
Author¢ ' nature (C�ptracto ompany.or Owner Perfortning Installafion) Phone �1 646-2911
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EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY