P - 79346❑ REQUEST FOR ELECTRICAL INSPECTION
�'� � 1 �- 615 p Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� (651)642-0800TTY/MRS 1-800-627-3529 www.electnctty.state.mn.us
❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
KCEL EhlEi?GY �AVER`S SV�ITCH
GENERAL FEES Outdoor Liahtinn Siandard (�a. $1
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
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 @$60
Fee
3 to 12 Units @$50 Per Unit (minimum tot21 fee is $20) � $20.50
E2Ch Additional Uni� @$25 .�ns nREn Fae inavecrors usE orar
i hereby cer6fy thffi I inspected the electrical installa6on described herein on tl�e da0es stated:
OTHER ADDITIONAL FEES �(�jc5 lF ^ at g� 3
I inhfinn Rnhnfif n S 95 nPr Firfum
_�.,�.r.�__. �.�,...--�-...�..
�� �� ��) �� � �� ��f � ��� ��'�) �� ��� �) �� �� � ��
�,773b158
��� � I
���
020 •S �3
rtequest uate: Rough-in Inspection Required? LJ Yes LINo Inspection Other Than Rough-In: LJReady Now LJ VYII Call
Qgj20f � You must call the inspector when ready! Date Ready:
1 ced+fy that I am the C�¢ICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of 1hE electrical work at:
Job Site Address (Street, Box, or Route No.) City Zip Code
1568 FEF7NDALE AV� NE FRiDLEY 3�v432
Sedion Township Range Fi2 No. County
�.� ���
pwr�edOccupent Name -., f� . Pl�se Provide Two (2) PFione Number(s) Ir�luding Nea Code
OLSOt�4 PETER A ( i ( �
Power Supplier Power Suppli� Address
XCEL ENER4Y
ConVaqor / Company Name ConVactor License Number AAaster pectrician ar Power Limited Technidan
HUNT ELECTRIC COftPORATfON CA 00883 Ucense Number
Meiling Address (Contracta, Company w Owner P�tortning InstallaGon)
asoQ ���rro�� Raaa . s�r,� ��u�, r�rs ss� ia
Authorized Signature (Cornractor, Company a Owner Performing InstallaGon) Pr,o�e (s�
�� 65i 846-2911
INSiRUCTiONB ON BACK OF YELLOW COPY BOARD OF ELECTRICITY COPV E&00001M14 8.1.1002