P - 79936REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
° 1-396-175 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYlMRS 1-800-627-3529
www.e%ctriciry.state.mn.us '' �
Identity the work covered by this request:
O�IEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GEN.SRAL FEES
SERVICES ( POWER SUPPLIES
401
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or A paratus �$.50
ADDITIONS TO THE GENERAL
MULTIFAMILY DWELLINGS (PER UNI�
3 to 12 Units @$50 Per Unit
Each Additiona{ Unit � $25
OTHER ADDIT�ONAL FEES
li htin Retrofit �$25 r Fixtuie
Center Pivot Irri tion Boom �$40
Manufactured Home Park Lots � $25 �
RecreaHonal Vehicle Park Sites � $5
Se arate Bondin Ins 'on � $2U
S ial Ins 'on �$30 er Hour
Soecial Insoection � $.31 oer Mile
XCEL ENEROY SAVER'S SWITCH
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Addi6onal Inspection Trips � $20
TOTAL FEE
total fee is $20)
FOR MSPECipp USE ONLY
I herebv carlilv that I insDectetl Me electrical installation descAbed
DATE
DATE � I
� Z � C
FOR OFFICE USE ONLY
I Illifl lilll ilf� Ilill 11�1 fll� II�I 11111 Iiil illl
* 1 3961 750* L�iS� �5�
Reque�t 8�A.2 Rough-in fnspection Required? ❑Yes [�rNO Inspection Other Than Rough-in: 6�Ready Now ❑ Will Call
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,�1r� sox�IVERVI�E��M11 TER Tr1E ��Ty FRIDLEY Lp �8 55�13
Section Township Range Fire No. County a��p
Occupant Phone
NIELSEN MAYNARD A
Power Supplier Address
�L �Y
Electrical Contractor ! Company fdame Cantractor License Number Master License Number
HUMT ELECTRIG CX�QRATI4N CA 80883
Mailing Address Contractor, Company or Owner Performin Installatlon)
2300 �TC]titAL ftdAD , SAiN79PAUL, MN 55114
Authorized ' nature (C�iractor, ompany or Owner Performing Installation) Phone
�i1 B�16-2911
EB-00001A-13 71112000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY