P - 80186` REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
< 1-396-149 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 —
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. sta te. mn, us
IdentiTy the work covered by this request:
CI'Y�IEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES
SERVICES / POWER SUPPLIES
� ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
3 to 12 Units �$50 Per Unit
Recreational Vehicle Park Sites �
Separate Bondin� Inspection � $:
�Lt'.�'� �i4L`i4t�^�' 3?4JL<<F"5'3�Q4'r�. '
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service ancUor Power Supply up to 500 Amperes, All
Circufts and Two Inspection Trips Each Dwellirg Unit �$80
TOTAL FEE I ��� I
total fee is $20)
f-0R INS7ECTOR USE ONLY
1 hereby cerlily Mat I inspecfed Me electncal installation tlescribed herein on tl�e detes sletetl:
PWGM IN DATE
FINAL MISPECTION /� �ATE
� � �-'� �. � _ � _ _ � � � ` � � � � 1rY�Jiw[Ja�.e—�= _ __ _ � � _ ` � � � � �
FOR OFFICE USE ONIY
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1 3961 495 v� �•�
RequesLD„�. �,� Rough-in Inspection Required? ❑ Yes f•jNo Inspection Other Than Rough-in: ❑ Ready Now ❑ Win Call
uts�i �� � h
You must cell the inspector when readyl Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No. City 2ip Code
851 1{EfYIW4ST�C?IV DR NE FRIDI.FY 55432
Section Township Range Fire No. County A�a
o� JANSC)N JERALD P � J C7 U=:� ' P� ,
Power Supplier Address
XCEL ENERGY
Electrical Contractor / Company Name Contractor License Number Master License Number
HUNT ELEGTRIC GORP�"JRATI4N CA 00883
Mailing Address Contractor, Company or Owner Performin Instatlation)
� �T4RIA� �AO , SAINI�PAUI,, MN 55114
AutFwrized Si nature (Contracfor, Company or Owner Perfortning Installation) Phone
� �� 651 �fi-2911
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY