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P - 760221��� 0�� � REQUEST FOR ELECTRICAL INSPECTION � � Minnesota Board of Electricity 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 (651) 642-OS00 TTY/MRS 1-800-627-3529 www.edectricity.stale.mn.us ' De�cr'tbe -using the back of the white copy if ne���ne ����y�,���t; S S4J I TCH e. GFNFRAI FFFS f1�drVnnr I inhHnn Sfandani /nl G'I CIRCUITS OF LESS THAN 50 VOLTS �ystem Device or Apparatus @ $.50 ADDITtONS TO THE GENERAL FEES 3to12 Traffic Sianal Standard Transformer / Power Su I far Si ns / Outline Li htl $5 ONE & TWO FAMILY DWELLINGS, EACH UNR Includes the Service andlor Power Supply up to 500 Amperes, All Circuits and Two Inspection Trips Each Dwelling Unft @$80 Additional Ins ctlon Tri $20 Investigative Fee Reins ction Fee @ $20 TOTAL FEE ^,L(j, �{j (minimum total fee is $20) rwsaaFa Foa wsrECroa use o�v I hereby certiry that I inspecled the elechical InstallaGon described herein on the detes stat�i: � WST�ALLATION MAY BE ORDERED DISCONNE� �-06' I IOT COMPLETED WITHIN 12 MONTHS ___ �II� II�II III� 11111 III�� IIII) IIIII IIII� II III I II�I Y � . 17870775 `r�°✓� �� G�� � A�' Raugh-in Inspection Requlred? ❑Ye �] No Inspection OtherThan Rough-In: [�Ready Now ❑Will Call �]%�:Dr��OGi You must call the inspector when ready! Date Ready: I e�y that I am the I� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work afi JobSiteStreetAddress ��'F�iIpLEY f�h! 5543�— 14a hl� TALhiAl?GE I�A 4' 3�5� To+anship Section Range Fire No. County �r�aic� � L�F�,s N����vL � Please Provide Two (2) Phone Numbers Including Area Code 14 ! � � ` - � 1 XCEL �IdE�,GY Confractor / Company Name I-IUhtT ELEC�'FiIC COFiF'QFdATI0h�1 M�iling Address (ConVador, Company or Owner Perfortnii �,:r00 TEF:EITOfiTAL fi0AD9 SA Installadon) .onvaaor ucense rvumner mascer tiecmc�an o� Nower Irmttetl T�hnii [;(�` Q(j$�yj LlcenseNumber q �lh! 55114 Please Provide Two (2) Phone Numbers Inciuding Area Code ���� ���—�9�� i )