P - 77031REQUEST FOR ELECTRICAL INSPECTION ���'F;`^�
�`r � �g � 1 � � � Minnesota Board of Electricity t :'��
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 `�. :��
#6873 (651)642-0800TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us ��
Describe -using the back of the white copy if necessary - the work covered by this request:
Replace damaged service mast.
GENERAL fEES Outdoor Lighting Standard $1
SERVICES I POWER SUPPLIES � Traffic Sipnal Standard na. $5
Above 200 Am ere $10
ALARM, COMMUNICATION, REMOTE CANTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aoaaratus al� $.50
Each Additional Unit @ $25
OTHER ADDITI01
Lighting Retrofit @ $.25 per Fixture
Center Pivot Irriaation Boom al� $40
S iallns ion $.31 per Mile
THIS INSTALLATION MAY BE ORDERED
iII�II���II�I�I�II����II��I��� ���I�II�I���
18391888
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ion Tri s $20
Investi ative Fee U 1 C 3 L" 2 .}`
Reins ection Fee $20
TOTAL FEE
(minimum total fee is $20) � 3 0. 5 0
R115 PREA FOR INSPECTIXt USE ONLY
I hereby cert'rfy that I inspected the elecVical installation desaibed herein on the dates staled:
_ � _
IF NOT COMPLETED WITt
Date: Rough-in Inspection Required? ❑ Yes � No Ins
pection Other Than Rough-In: � Ready Now ❑ W ill Call
�' ���' 9/�� you must call the inspector when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR �I COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Site Street Address Ciry
6547 Oakley Dr�.ve }��iI�D��t Fridlev
Township Section Range Fire No. County
Anoka
Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
John Kurak �763� 571-1195 � �
Electrical UtilRy E�ectrical Utility Address
Xcel Energy Mp1s.,
Contractor / Company Name Contrador License Number Master Electrician or Power Limked Technici
License Number
He;.ght=s Electric, inc. CA000827
Mailing Address (Contractor, ' n)
704 40t_h Ave NE, Colurnbia tiei.ehr.s, NiPv �5421
�_�r��� I �763� 788-8888 � �
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