P - 77163REQUEST FOR ELECTRICAL INSPECTION , ,., � �"�
1 � 8 �'� � � � � � Minnesota Board of Electricity �- �
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 �`
#(�q2� (651)642-0800TTY/MRS1-800-627-3529www.electricity.state.mn.us ��!;�
Describe -using the back of the white copy if necessary - the work covered by this request:
Relocare electrical panel for easr. tenant ��� �j31
GENERAL FEES Outdoor Li htin Standard $t
SERVICES / POWER SUPPLIES Traffic Si nal Standard $5
0 to 400 Ampere @$25 �/ Supplemental Fee $20
401 to 800 Am re $50 Transformers u to 10 KVA $10
Above 800 Amoere C� $75 Transformers over 10 KVA a(� $ 20
ALARM, COMMUNICATION, REMOTE CANTROL, SIGI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus a$.50
ADDITIONS TO THE GENERAL FEES
Each Additional Unit @
Center Pivot Irriqation Boom
Inciudes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Additional Ins ection Tri s $20
Investi ative Fee s u r cha r e
Reins ection Fee $20
TOTALFEE
Iminimum total fee is $201 $ 6 �.��
I insceded the eleeUical installation descri6ed herein on the dales stated:
S ecial Inspection $.31 er Mile
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS
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18391953
Date: Rough-in Inspection Required? ❑ Yes � No Inspection Other Than Rough-In: � Ready Now ❑ Will Call
�, 2� 1� � n� You must call the inspecto� when ready! Date Ready:
I certify that I am the ❑ LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Site Street Address Ciry
1375 Skywoocl Lane Frl.dle
Township Section Range Fire No. County
Anoka
Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
�Ja}�ne Johnson �651� 481.-9672 � �
Electrical Utility Electrical Utility Address
Xcel Energy i•,pls
ConVactor / Company Name Contrador License Number Master Electrician or Power Limited Technician
License Number
iiE I GHTS EIrECT12 I C, INC . CA000827
Mailing Address (Contractor, Company or Owner Perfortning Installation)
704-40th Ave NE Columbia He�. hrs, LIN 55431
Authorized Signature (Co tractor or er rforming Installation) Please Provide Two (2) Phone Numbers Including Area Code
� �� ( 76� 788--f3888 � �