P - 75769REQUEST FOR ELECTRICAL INSPECTION
1����- 9 2 5 1❑ Minnesota Board of Electricity �;
1821 University Avenue Sufte S-128, Saint Paul, Minnesota 55104
(651)642-0800TTY/MRS 1-800-627-3529 www.electvicity.state.mn.us
Descri6e -using ihe back of the white copy'rf nece.ssa the work covered by this uest
EXC�L EhIEFiGY �AV��i°S SW2TCH
SERVICES I POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
3 to 12 Units @$50 Per Unit
OTHER ADDITIONAL FEES
Hour
Fee
Includes the Service andlor Poarer Suppiy up ro 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
Addfional Inspection Trips @ $20
Investiaative F�
iviw�rtt �Oe�O
total fee is $20)
thffi I inspected the electrical ins[allation d�cnbed herein on the dates stated:
-� �-� �
TFtIS INSTALLATIOPI MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 12 MONTHS ________�
I(IU II III A u� I) UI II �I I�I�I I� (II �III u� I lui
17819251
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��� Rough-in Inspecdon Required7 ❑ Yes �] No Inspection Other Than Rough-In: �Ready Now � Wfll Call
�.�"��"0��6 Youmustcalltheinspectorwhenreadyl DateReady.
I ceitity that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
�a�s�sv�cada�� c�yFFiTDLEY I�hl
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Townghip Section Range Fire No. County
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Owner/Occupant Name Please Provide Two (2) Phone Numbers Including Area Code
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Eledrical Utility Electrical Utility Address
XGEL Eh9ERGY
Contractor / Company Name Conbactor License Number Master Electrician ar Poxrer Limited Technician
HUhlT ELECTFiTG COFiF'OF{Ai'ION C(a pd�g,; LicenseNumber
MaFINg Address (Contractor, Company or Owner Perfarming Installation)
��Ot) TEFiFiTiQFiIAL �iGA%�q SATI+IT F'AUL, t�h� 5511�
AuthorPzed SI �ra (Contractor or Owner Perfortning Installation) Please Provide Two (2) Phone Numbers Including Area Code
%'c� (6�� 64b—�911 � )