P - 79918REQUEST FOR ELECTRICAL INSPECTION ,
Minnesota Board of Electricity
, . 1-396-142 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYIMRS 1-800-627-3529
www.electricity.state.mn. us
� Identity the work covered by this request:
0 REPAIR
401 to
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUfTS. CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aonaratus � 5.50 �
I MUL
FORU!@
XCEL ENER{�Y SAVER'S SWiTCH
Transfortners over 10 KVA � $20
Transfortners / Power Supply tor Signs / Outline Lighting �
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, Atl
Circuits and Two Inspection Trips Each Dwelling Unit �$F
Additional Insnection Trios � $20
FOR INSPECTOP USE ONLV
TOTAL FEE
Manufactured Home Park Lots �$25 I hereby certify ihat I inspected the electncel inslallation descnbed herein on the datea stated:
RecreaCwnal Vehicle Park SRes �$5 RoucM �N on�
rate Bondin Ins ion � $20 (�+�
S ecial Ins 'on �$30 er Hour FINAL INSPECTION DATE
S ecial Ins 'on �$.31 er Mile "-( �� c 3
__THIS INSTALLATIQN_MAY B� ORDERED DISCONNECTEQ IF_NOT �4MPL�T�D 1�lU�l�Mf��THS _
FOR OFFICE USE ONLY
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1 3 9 6 1 4 2 0 �
Reque�l ��� Rough-in Inspection Required? ❑ Yes [�No Inspection Other Than Rough-in: I�Ready Now ❑ Will Call
� You must call the inspector when ready! Date Ready:
I certify that I am the f� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and here6y request inspection of the electrical work at:
Job Address f�r g�, Bo��[�p,�� NE C�ry F��Y Zip Code �,�1
JLJd VIV
Section Township Range � ir County A�A
Occupant Phone
B�NA JAMES R
Power Supplier Address
%ic� En�v
Electrical Contrector / Company Name Co�tractor License Number Master License Number
HUNT ELEGTRIG C�FiP�ORATION CA 00883
Mailing Address (CoMractor, Company or Owner Performin Installation)
230� TERRITC)RiAL l�Ad , SAINT�PAUL, MN 55114
Authorized Si naTure (C�ractor,�Companyror Owner Performing Installation) Pho�e
�51 846-2911
EB-00001A-13 7/1/2000 BOARD OF ELECTFICITY COPY INSTRUCTIONS ON SACK OF YELLOW COPY