P - 79989REQUEST FOR ELECTRICAL tNSPEC710N
Minnesota Board of Electricity �'
1-396-171 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-OS00 TTY(MRS 1-800-627-3529
www. e%ctricity. sta te. mn. us
Identify the work covered by this request:
OMIEW ❑ REMODEL O ADDITION ❑ REPAIR
� ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
XGEL EhlERt3Y SAVER'S SWiTCH
to
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two fnspectian 7rips Each Dwelling Unft �$f
Additional Insoection Trips � $20
FOfl INSPECTOR USE ONLY
ROUGNIN
FlNAL INSPECTION
desCribed herein on Me dates :
DATE
DATE
,��G3
,NTHC _�R
FOR OFFICE USE ONLY
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* 1 3 9 6 1 7 1 9�" �'� ot�'�
RequeSCQ9tg�2 Rough-in Inspection Required? ❑Yes �No Inspection Other Than Rough-in: L7Ready Now ❑Will Call
�311 You must call the inspector when ready! Date Ready: ��
I certify that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City 7rP �de
211 Rlf� CREEK TER NE FR�DLEY 55�32
Section Township Range Fire No. County A�A
Occupant PFwne
K�VAC�1 PETER J f ��j
PoWe� s�pprer naaress
iac� �r
Electrical Contractor 1 Company Name Contractor License Number Master License Number
HUidT ELE�CiRiG t�RPORATION CA 00883
Mailing Address (Contractor, Company or Owner Perfortning Installation)
2300 TER12iTdR1Al i�AD , SAINT PAUL, AAN 55114
AuthorizedSignature (Contrector, Company or Owner Perfortning Installatio�) Phone
�r�, �p� �51 �4�-Z$14
EB-00001A-73 711/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY