P - 79191� REQUEST FOR ELECTRICAL INSPECTION
� �` � � � - 510 � Minnesota Board of Electricity
w 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TIY/MRS 1-800-627-3529 www,electrlcity.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -usin the back of the white copy if necessary - the work covered by this request:
XCEL EPIERGY SAVEI�'S SWfTCH
�ENERALFEES
401 to 800
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Vill(
Outdoor Liqh6nq Standard
� Transformer / Power Supply for Signs I Outline Lighfing @ 85
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service artd/or Power Supply up l0 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
TOTAL FEE I
(minimum total fee is $20) 2����
TMSAREAFpRIl6PECTORUSEdIv
I hereby certify Mal I inspected Me electrical installa6on described herein an Me dames slaAed:
• t
� Special Inspection @$.31 per Mile � �
'HIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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Request Dffie: Rough-in InSpection Required? ❑ Yes ❑ No Inspection Other Than Rough-In: ❑Fteady Now 0 WNI Call
d7��� You must call the inspector when ready! Date Ready:
I certify that I am the �%I�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of ihe electrical work at:
Job Site Address (Street, Box, or Route No.j City Zip Code
653 KIMBALL ST NE FRiDLEY 55432
Sectiort TownshiP Range Fire No. County �a�
Owner/Occupant Name � w.. Please Provide Two (2) Phone Numb�(s) Induding Nea
HAMRE DENNlS L ( � ( �
Powe� Supplier Power Supplier Address
XCEL ENER�Y
ConVactw / Company Name ConVaclor License Number Master Electridan or Power Limited Technician
t�urvr e�e��e eoR�ow�-norv eA ooes3 ��^� "�^'�'
Mailing Address (Contr�, Campany or Owner Performing Installation)
230D TERR170RIAL ROAD , SAlNT PAUL, MN 551 i4
Authorized Signature (CoMractor, Company or Owner Perfortning Installffiion) Phone (s)
�� 651 648-2911
IN87RUCTONS ON BACK OF VELLOW GOPY BOARD OF ELECTRICITY CAPV EB•OOOOtM14 8.7. 2002