P - 79329REQUEST FOR ELECTRICAL INSPECTION
�` Minnesota Board of Electricity
,� 7 7 3�- 5 9 6 00 1821 UniversityAvenue Suite S-128, Saint Paul, Minnesota 55104 �
(651) 642-0800 TIY/MRS 1-800-627-3529 www.electriciry.state.mn.us
NEW ❑ REMODEL ❑ ADDITfON 0 REPAIR Describe -using the back of the white copy If necessary - the work covered by this request:
XCEL ENERGY SAVER'S �'WI?CH
�ENERAL FEES Outdoor Lighting Standard @$1
I ALARM, COMMUNICATION, REMOTE CONTROI
� CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or Aooaratus Ca? $.50
Per
� ����ii�i�i���i�i<<i��
� ���� �� iii � � i� �� �i i�
17735960
Transformers u to 10 KVA $10
Transformers over 10 KVA $ 20
Transformer / Power Supply for Signs / OuGine Lighting @$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
I�cludes the Service andlor Power Supply up to 500 Amperes, AI!
Cirouits and Two inspeclion Trips Each Dwelling Unit �$80
(minimum total fee is $20) � $20.50
iHIS PItFA FOR INSPEC�OF USE 011Y
I hereby certify that I inspected the electrical installation described herein on tlie da�es stated:
, � 5�. 7 /
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lRequesT Date: Rough-in Inspection Required? Ll Yes LYIYo Inspedion Other Than Rough-In: LI dy Now � YWII Ca�l
�g('zOroQ I Yau must wll the inspeclor when ready! Date Ready:
I certi(y that I am the C�ICENSED CONTRACT t�jY ❑ OWNER and hereby request inspec8on of the elechical v�ro�C at::
Job Site Address (Street Box, or Route No.) ZD �
R 0121 Z ONONDAGA WAY NE � FRIDLEY 55432
SVENNlNGSEN RlCHARD J S ( )
ver pplier Power Supplier Address
XCEL EN�RGY
rtrector I Canpany Name Contracia License Num
Hurvr e�e-rRac c�Rpv�-�o� c,� c►�as�
iling Address (Contractor, Company or Owner Performing Insfallation)
230� TERRITORIAL ROAd , SAIt+1T PAUL, MN 55114
horized Si9�sWre i�ntracta, ComDanY a�� ��ing Installatlon)
IN$TRUCTpNS ON BACK OF YELLOYV COPV BOARD OF ELECTRICRY COPV
Ah10KA
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M8518f GBCIflp8fl Of
License Number
85i 64&2911 �
E&00001M74 8.1.2002