P - 79228REQUEST FOR ELECTRICAL INSPECTION
1�� V O- 5 5 6 Q Minnesota 8oard of Electricity -
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYIMRS 1-500-627-3529 www.electricity.srate.mn.us
) NEW ❑ REMODEL O ADDIZIQ�EL �.tEP�I@ �esctibe; u,�p,the b�ckof�b��dhite copy if necessary - the work covered by this request:
x �N RGY SAvCK'u V�ii t M
SERVICES / POWER SUPPLIES
AIARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
Center Pivo! Irriaation Boom
.�,
Siandard � $1
over 10
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
(minimum total fee "�s $20} � 2D,50
THIS AREA FIXt IlSPECiOR USE 011Y
I hereby certify Nat I inspettetl Me electrical insWla6on described herein on Me da�s sta�d:
1
� �Il�lll�ll�lll�lf IIIIIII�IIIIIIIII H�II R �
� � 4699
L76f�5561
o�OC'�`� � C?� � �� �JI'
Request Date: Roughtin Inspection Reyuired? ❑ Yes ���
�%/3Qf�{ Inspection Other Than Rough-�n; � ady 1�q�, [] y�ll Ca11
You must call the inspecta whp.n ready� Date Read :
� certify that I am the ❑�ICENSED CONTR,4CTOR (]CO►�ApqNy y
Job Site Address (Street, BoX or Route No.) ❑ OWNER and hereby request inspection of the elactrical ►erork at:
62! 1 RiCE CREEK DR NE c��
T....,....�:_ FRiDLEY
RC�ACH MICHREL J " `�'�� �
� w \ �
i.�' •
Fower SuPdier
XCEL ENEROY �ef PPIi� Address
Contractor / ComP�Y Name
hfUNT ELECTR(C CORPORATION Contractor License Num
"�'�"'g'`�d`� «'��� �P�y or O�yner per(qming Installatipn) CR QD888
2300 TERRITpR�qL Rp,qQ gq�(y� pAUL„ MN 55114
��� '����'�a Owner Perfortning InstaUation)
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iHSncucnons on s�cK ov reu ow conr
80ARD OF ELEC7FtfCRV COPY
� 55432
ANOKA
: Two (2) phone Number(s) Induding Nea Code
\ �
Master EJectriivan or Pow� Limited Technia�
ucense Mumber
ne (s)
BS] 648-2911
E9•OOOOtA-14 8.1.2002