P - 79290REQUEST FOR ELECTRICAL INSPECTION
� �- 5 3 9 Minnesota Board of Eleetricity
1 � 1821 University Avenue Suite 5-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electricity.state.mn.us
O NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XGEL ENERGY Sfi'�'�??'� S'WiTCH
GENERAL FEES Outdoor Li htin Siandard $1
SERVICES i POWER SUPPLIES Tr�c Sional Standard (a� 55
CIRCUITS 1 FEEDERS
0 to 200 Ampere @ $5
Above 200 Ampere @$10
ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Transformers over 10 KVA $ 20
Transiormer / Power Supply for Signs / Outline Lighting @$5
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
3 to 12 Units @$50 Per Unit (minimum total fee is $20) � $20.50
EaChAdditiOnalUnl�@$25 � Twso.nEnFacuaaECrcnusE«ar
I hereby cerOfy that I inspecled Me elecOrical installation described herein on the dates stafed:
OTHER ADDITIONAL FEES �Oe �y ^ O � � ��
Liahtina Retrofit � $.25 ner Fi�Aure �
{ Special Inspection @$.31 per Mle �
THiS INSTALLATION MAY BE ORDERED
I�� � iii II �{ 11 � N iN 1114{ I{�n ii Hi II NI I I�I
L77�S3"�0
f�squest oate: Rough-in Inspection Required? LJ Yes
Ggf��i3,q You must wll tFie inspector when readyl
{ certity that I am the ❑ji�ICENSED CONT C C PAN
Job Site Address (Street, Box, w Route No.) City
?376 STINS4N BLV
ROAME BRENDA tC
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Inspedion Other Than Rough-In: O ady Now � Will Call
Date Ready:
❑ OWNER and hereby �equest inspectio� of the electrical work at::
FRIbLEY 55432
County
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Please Provide Two (2) Phwie Number(s) Iruluding Area (
� / � /
XCEL ENERGY
Cantractor / Company Name ConVacta License Numl
HUNT ELECTRIC CORPORATION GA 00883
Mailing Address (ConKactor, Company w Own� Performing Installation)
23Q0 TERF7ITORIAL ROAD ,�RrNT f�AUL, MN 5511a
Authorized 3igrreture (Contratxor, Company a Owner Perfortning Installation)
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INSTRUCTIONS ON BACK OF YELLOW COPY BOARD OF ELECTRICI7V COPY
MeSt� GBG�Gef1 Of
License Number
651 646-2911 �
EB•OOW1M14 8.1.2002