P - 79340REQUEST FOR ELECTRICAL INSPECTION
�� 7 7��� O n � Minnesota Board of Electricity -
�5 1821 University Avenue Suite S-126, Saint Paut, Minnesota 55104
` (651) 642-0800 TTY/MRS t-800-627-3529 www.electricity.state.mn.us
0 ADDITION � REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
}4CEL ENERGY SAVEft'S S�IITCH
GENERAL FEES Outdoor Lighting Standard @$1
0 to 400 Ai
401 to 800
UfTS /
Oto20
ALARM, COMMUNICATION, REMOTE GONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE �ENERAL FEES
Each
Center
Ilii II 1� II lN f! IN !! lil Ii Hl ��1 II 111 �� f lI�
17736Q83
f"�l1
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 �$80
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20) $20.50
- THIS PREA Fp21N5PFCTd2 USE ONLV
I hereby certify that I inspecled the electrical installa6on desGribed herein on tt�e d�es sfated:
�
' /2 ��.'7 �
ao �s�a
Request Date: Rough-in Inspection ReQuired? ❑ Yes Inspedion Other Than RaigMn: ❑ dy Now O VJII Call
��%2� You must call the inspector when readyl Date Ready: �
I certify that I am the C�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of tt�e electrical work at•:
Job Site Addross ( treet, Box, w Route No.) Ciry Zip Code
6S 1 s FRIDLEY ST NE � FRIdLEY 5,rs432
Sedion TownshiP ��� . N t. �C..) CouMy
J�1�0�
OwnerlOccupent Name Please Provide Two (2) PF�one �mber(s) Induding Area Code
HARDY BRIAhJ L ( � ( �
Power ier Power SuppYi� Address
}tGEL ENER�Y
Contrador / pany Name Vactor License Number Master Electrician a Power Limited Technidan
i-IUNT ELECTRi� C4RPORATION CA OOB83 ticense trumeer
Mailing Address (Contracta, Company w er Performing installation)
2300 TERRITORIAL ROAQ , SAINT PA:U�, MN 551 i4
Authorized Signetwe (Contractw, Company or Owner Perfortning Installatlon) Phone (s)
�� 651 646-2911
4N87RUCTONS ON BACK OF YELLOW GOPY BOARD OF ELECTRICITY CAPV EB-00001M14 8. t. 2002