P - 80000�` REQUEST FOR ELECTRICAL INSPECTION ..-� .
* � Minnesota Board of Electricity
1-396-16$ �J 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity.state. mn, us
IdeMify the work covered by this request:
OiLIEW ❑ REMODEL ❑ ADDITION ❑ REPAIR XCEL ENERQY BAVER�S SWITCH
CIRCUITS / FEEDERS Transfortners / Power Su I for Si ns ! OuUine Li htin �$5
0 to 200 Am ere �$5 ONE 8 TWO FAMIIY DWELLINGS, EACH UN{T
Above 200 Am ere �$70 Includes the Service and/or Power Supply up to 500 Amperes, All
AL4RM, COMMUNICATION, REMOTE CONTAOL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS. CIRCUITS OF LESS THAN 50 VOITS Additional inspection Trips �$20
Each S stem Device or A aratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES fieins ection Fee �$20
MULTIFAMILY DWELLINGS tPER UN TOTAL FEE
a f„ ,� � �,,;r� � s�n aa� � i��r fminimum total fee is $201
usE ara�v
Home Park Lots �$25 i nereny ��ury ma� i ��scacced ma a�ri�
'ehicle Park Sites � ROUGH IN
iing Inspection (� $ �/-�-- �/-- �i�`J�-� �
+Nnn A 9:M ncr Hniv `-� • l• Il 1 FINAL INSPECTION
DA7E
DATE
-zF- 03
FOR OFFlCE USE ONLY
I I��II� fl�ll (�II� �I�� I�II� Ill�f �� ��� I��
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RequestQalC�2 Rough-in Inspection Required? ❑Yes �NO Inspection Other Than Rough-in: QReady Now ❑ WiU CaA
US/l 1C
You must call the inspector when ready! Date Ready:
I certify that I am the f� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
�%�. Q��� � � ��� .�1.�'.�
Section Township Range Fire No. County A��A
��UPaSCF1iY11DT JUi.iE A j �, Pnone
Power Supplier Address
XCEL ENERGY
Eleetrical Contractor 1 Company Name Contrador License Number Master License Number
HUf+li ELECTRIC OORPORATI4N CA 00883
Mailing Address {Contrector, Company or Owner Performing Installation)
2300 TEfiRITORIAL RC}AD , SAIKf PAUL, MN 55114
Authorized Signature (Contractor, Company rn Owner Performing Installation) Phone
� ,,,�rrl�wt� �i1 6�9-Z$11
E&0OOO1A-13 7!1l2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY