P - 79935M REQUEST FOR ELECTRICAL INSPECTION �.,,
Minnesota Board of Electricity
, 1-396-174 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642-0800 TTY/MRS 1-800•627-3529
www. electricity. state. mn. us
Identity the work covered by this request:
L7REW ❑ REMODEL ❑ ADDITION O REPAIR
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNAIING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A paratus �$.50
ADDITIONS TO THE GENERAL FEES
3 to 12 Units �$50 Pi
Each Additional Unit �
Home Park
'ehicle Park
XCEL ENEROY SAVER'S SWITGH
Transformers over 10 KVA (� $20
Transfortners / Power Supply for Signs / Outline Lighting �$:
ONE & TWO FAMILY DWELLINGS, EACH UNIT
I�fudes the Service andlor Power Supply up to 5W Amperes, Aii
Circuits and Two Inspection Trips Each Dwelling Unit �$8U
Additional Inspection Trips � $20
• Investigative Fee
Reinsoection Fee � $20
FOf11NSPECTOf1 USE ONLY
IN
thet I insoected t�e electncal
TOTAL FEE I � �I
total fee is $20)
DATE
�.z.� og
FOR OFFICE USE ONLY
I I111111�N �III IIf� �iII iiIII lilli HIU Nll f�l
* 1 3 9 6 1 7 4 3" �� �%��
Reque��r2 Rough-in Inspection Required? ❑ Yes l�No Inspection Other Than Rough-in: �Ready Now ❑ Will Call
You must call the inspector when readyl Date Ready:
I certity that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address���, soX�VERV{E�M TER NE ary ��Y zP c«ia 55�132
Section Township Range Fire No. County A��a
Occupan�ERBER RICHARD HENRY � �% Pho�e
s
Power supp�ier a.aaress
�L �Y
El�trical CoMractor 1 Comparry Name Contrador License Number Master License Number
HUhtT ELEGTRtG 04RPORATION CA Od883
Mailing Add�ress (Co�nt�`TC7Fi1ALYRQAD � SA1 �� PAUL, �N 551 i 4
Autharized Signature (Contractor, Company or Owner Performing Installatlon) Phone
� ��� 651 646-2911
EB-00001A•13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY