P - 79172REQUEST FOR ELECTRICAL INSPECTION
Y� � f ��- 9 7 3❑1 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
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL ENERGY SAVER'S SWITCN
GENERAL FEES Outdoor Li hGn Standard $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Am re $25 Su lemental Fee $20
40110 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Am ere $75 Transformers over 10 KVA $ 20
CIRCUITS / FEEDERS Transformer / Power Su I for Si ns / Outline Li hGn $5
0 to 200 Am re $5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re $10 Includes the Service and/or Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit @$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins tion Tri s $20
Each Svstem Device or Apparatus �$.50 Investigative Fee
3 to 12 Units @$50 Per Unit
Each Additional Unit @ $25
OTHER ADDITIONAL FEES
Liahtina Rehofit � $.25 oer Fixture
(In� IIIII IIII� I��II IIII) II�I IIIII IIIII III� I�
�,757R731
(minimum total fee is $20) � 20.50
THIS PREA FOR INSPECiIXi USE OfIY
I hereby cerOfy that I inspected the electrical instalW6on described herein on tlie da�s sfa0ed:
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;OMPLETED WITHIN 12 MONTHS
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Request Date: Rough-in t�spection Required? Ves No Inspedion Other Than Rough-In: y Now � Will Call
� 1 �j ��Q�i You must call the inspecla when ready! Date Ready:
I certify that I am the $I LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at::
Job Site Address (Street, Box a�te Na.) City Zip Code
290 RIGE CREEK BLYD NE FRIDLEY 6643Z
Section Township Range Fire No. CaiMy
J�0�1
Owner/Occupant Name r, ♦ Please Provide Two (2) Plione Number(s) Induding Area Code
HUFF LA REE E 3 O I� 1` ( ) ( �
Power Supp(ier Power Supplier Address
XCEL ENEROY
trector / Company Neme CanVactor Lice�se Number Masler Electridan a Power Limited Technieian
HUNT ELECTRIC CORPORATION CA 00883 V�� Number
Mailing Address (Contracta, Company or Owner Perfarming Installation)
2300 TERRITORWL ROAD , 3AINT PAUL, MN 55114
Huthorized Signawre (Contractor, Canpany or Owner Perfortn�g Installatlon) Phone (s)
'i�'�� 661 646-2911
INSTRUCTONS ON BACK � YELLOW COPY BOARD OF ELECTRICITV COPV E&00007A-1/ 8.1. 2002