P - 79173REQUEST FOR ELECTRICAL INSPECTION
t� r 1��.., 9 7 4�g Minnesota Board of Electricity -
1821 University Ave�ue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYlMRS 1-8QQ-627-3529 www.electricitystate.mn.us
NEW ❑ REMODEL ❑ ADDITION D REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL EIVERGY SAVER'S SWITCH
GENER4L FEES Outdoor Li hGn Slandard $1
SERVICES / POWER SUPPLIES Traffic Signal Standard @$5
ALARM, COMMUNICATION, REMOTE CONTROI
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each Additional
Fi#ure
I 1�II II 111 � I� 11 I�I 111N If 111 II !N 11 Iil !I Ni I I�f
1,757`1749
Transformers uo l0 1
ONE & TWO FAMILY DWELLINGS, EAGH UNIT
Indudes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � 20.50
iH15 RREA FOR INSPECTOR USE ONLY
I hereby cer6fy that I inspected the electrical installa6on described herein on tlie dafes stated:
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Request Date: Rough-in Inspection Repuired? Yes No Inspection Other Than Rough-In: dy Naw � VYdI Call
� ��� .��� Yai must call the inspecta when ready! Date Ready:
I certify that I am the � LICENSED CONTRACTOR ❑COMPANY ❑ OWNER and hereby request inspection of the electrical work aY.:
Joh Site Address (Street, Box, or Route No.) City Zip Code
6271 TRIIVITY DR NE FRIDLEY 6643Z
Section Township Range Fire No. County
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ien�wupan� rvams ��/ C/� > nease r
IYERS JONN �� �� ( )
�r Supplier �r Supplier Address
XCEL ENER4Y
itractar / Company Neme ContracWr L'fcense Num
HUNT ELECTRIG CORPORAT{ON CJ100883
ling Address (ConVactor, Company or Owner Performing Instaqation)
2300 T'ERRiTORfAL ROAD , 3r41NT PAUL, MN 55114
iorized Signature (Contractor, Company or Owner Pertorming Insfallation)
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�CTONS ON BACK OF YELLOW COPY BOARD OF ELECTRICT' COPY.
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M8St0f GCCI(5C18� Of
License ►�h,meer
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EB-OOOOtA-14 8.1.2002