P - 79328REQUEST FOR ELECTRICAL INSPECTION
�����- 5 9 5 z❑ Minnesota Board of Electricity �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
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{! NEW ❑ REMODEL O ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - lhe work covered by this request:
XCEL ENERGY SAVER'S SWITCH
GENERAL FEES Outdoor LiahUna Standard (� $1
ALARM, COMMUNICATION, REMOTE CONTROL,
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus na $.50
to 12 Units @ $50 Per
ach Addi6onal Unit @:
41�II {I IN II �I II IN {I NI �I I� II�II II �I II III I�I
17735952
to
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspeclion Trips Each Dwelling Unit �$80
Addilional Inspection Trips $20
Investiaative fee
TOTAL FEE I
(minimum total fee is $20) �2�.50
iw5 MEA FOR INSPECTpt USE OKv
I hereby ceNfy that I inspected the electrical installation described herein an the da�s stated:
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TED IF NOT COMPLETED WITHIN 12 Mi
,r�Sa 7 /
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Request Dffie: Rough-in InspecGon Required7 ❑ Yes ❑�Rlo Inspedion Other Than Rough-In: �k�ady Now ❑ Will Call
�]�(j%QQ You must call the inspectw when ready! Date Ready: �
I certify that I am the C�ICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecGon of tl�e electrical work at:
Job Site Address (Street, Box, w Route NoJ City Zip ode
1237 NORTON AVE NE FRIDLEY 55432
Section Township Range Fire No. CouMy
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Owner/Occupant Name ,-� Please Provide Two (2) Phone Number(s) Induding Area Code
KULSET SAMUEL D � `� ( � ( �
Power Supplier Power Supplier Address
XCELENERGY
Contractor / Compeny Name Contractor License Number Mast� FJectritaan a Power Limited Technician
HUNT ELE�`.TRIC CORPORATION CA 00$83 ���� �'m�
Mailing Address (Contrador, Campany or Own� Performing InstallaBon)
2300 TERRITORIAL ROAD , S�11NT RAUL, MN 55114
Authorized SignaWre (ConVactar, Company or Own� Perfortning Installation) Phone (s)
�� 651 646-2911
INBTRUC710NS ON BACK OF YELLOW COPY BOARD OF ELECTRICISY COPV EB•OOOOtA-14 8.1. 20D2