P - 78067REQUEST FOR ELECTRICAL INSPECTION
1����- 5 9 7� Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800�27-3529 www.electricity.state.mn.us
� NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the bxk of the white copy rf necessary - the work covered by this request:
GENERAL FEES Outdoor ' htin Standard S1
SERVICES I POWER SUPPLIES _ TraRc Signal Standard @ S5
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
MULTIFAMILY DWELIINGS PEI
3 to 12 Units � 550 Per Unit
Each Addition� Unit � E25
OTHER AD
Li htin Rehofit $.25 r f
Center Pivot irtioation Boom
Hour
IIII N I� II i� II !II II III I! III II Iil It III M� I
15335979
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service andlor Power Supply up to 500 Amperes, All 8 5
Circuits and Two InspecGon Trips Each Dweliing Unit �$80
Reins tion Fee $20
TOTALFEE $ 5 . 5 �
(minimum total fee is $20)
TipS MEA FOR INSPECTOR USE CNY
I hereby certiy Mat I inspecled the electrical install�on desaibed haein on tl�e da0es s�ed:
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ReQuest Date: Rough-in Inspedion Required? � Yes ❑ No Inspection Olt�er Than Rough-In: OReady Now ❑ WNI Call
10 — 21 — 0 3 You must call ihe inspeda when ready! Date Ready:
I certify that I am tlie �CENSED CONTRACTOR ❑ COMPANY 0 OWNER ar�d hereby req�st inspection of ihe electrical work at:
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1171 NORTON FRIDLEY
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XCEL ENERGY
16324
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Contractor Laenae number n�essoar �ednaan a Po�er timited recmiaan
CAO 1 9 3 6 "°°'� Nirnber
�wne. Perr«n,ing InsbMation>
VE N BROOKLYN PARK MN 55428
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` 763 537-0807
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