P - 79180.�-757-981�
NEW ❑REMODEL ❑ADDITION 0
XCEL EP
GENERALFEES
f0 4OO
IMMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
3vstem Device ar Apparatus � $.50
@ $50 Per Unil
ial Unit @ $25
Fixture
REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-080� TTYlMRS 1-800-627-3529 www•electricirystate.mn.us
R Describe -using the back of the white copy if necessary - the work covered by this request:
�Y SAVER�s swrreH
Outdoor Li htin Standard $1
Traffic Sianal Standard (a? $5 _ _
I 1�111111 H NI fl ill f11N �1� lllfl II IN !I {II I Ilfl
I
�,'�5798L4
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Sen�ice andlor Power Supply up to 500 Amperes, Ail
Circuits and Two Inspection Trips Each Dwelling Unit �$80
TOTALFEE
(minimum total fee is $20) 20.50 _
THIS AREA FOR INSPECiOR USE ON.�
I hereby certify that I inspected the ekwtrica� installafion described herein on the dffies sta0ed:
C(� �l 33 7S
� �i l
� • ��J
Request Date: Rough-in Inspection Required? ❑ Yes Q No Inspectia� Other Than Rough-In: �Ready NoM+ 0 1N�11 Calt
� ��f ���{ You must cali the inspector when reedy! Date Ready:
I certi(y that I am ihe $I UCENSED CONTRACTOR OCOMPANY ❑ OWNER and hereby Bquest inspection of tt�e electriCal work aY.:
Job Site Address (SVeet, Box, or Rnule No.) City Zip Code
298 ELY ST NE FRIDLEY 66432
SeUion Towruhip Renge Fke No. Caunty �O�
SAMMON DAWN M - � y � �
rer SuPPlier POwer Suppli� Address
XGEL ENEROY
iiractor / Company Name ContracWr License Nurt
HUNT ELECTRIC CORPORATION CA 00883
ting Address (Coniractor, Campany or Owner Performing InstaOatlon)
2300 TERFttTORIAL ROAD , 3A{M' PAUL, MN 55114
horized SignaWre (Contractw, Company or Owner Perfortning Instal�aGon)
t�� �l�ta�r�
iRUCTONS qJ BACK OF YELLOW COGY � BOARD OF ELEC?RICT' CAPY
� )
License Number
661 64fr2911 �
EB-00001M71 8.1. ZOq2