P - 79174REQUEST FOR ELECTRICAL INSPECTION
���'�� J�-� 9 7 5� Minnesota Board of Electricity -
1821 University Avenue Suite S-128, Saint PauV, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529 www.electriciry.state.mn.us
❑ REMODEL ❑ ADDITION 0 REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCEL ENERGY SA1tER'S SWITCH
GENERAL FEES Outdoor Lighting Standard @$t _. __
/ POWER SUPPLIES
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
to 92 Units @
ach Addi6onal
Retrofit Q $.25 per Fixture
'ivot Irriaation Boom � 84(
l(��l �l ��� ll ll� (� �I 8�ll I� III ll �� II III 1I �II ( I��
1,7a79756
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dweliing Unit �$80
Inves6 2tive Fee
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20) 20.50
THIS RREA Fqt Il6PECipi USE qJLY
I hereby cer6y ihat I inspected the electric� insWlaGon described Icerein on ihe dates sfa0ed:
C�- /l 3 3�
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�p.S ZS
Kequesc uace: Rough-in Inspaction Required? LI Y� L1 Np Inspedion Other Than Rough-In: CJReady Now LJ Witl Call
0111 Sl2004 You must call the inspector when ready! Date Ready:
I certify that I am tt�e ?� UCENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby �equest inspection of tl�e electrical work at:
Job Site Address (SVee6 Box, w Roule No.) City Zip Code
1560 TROLLHAGEN DR FRtDLEY 56421
Secbon Township � 0 �� l Fire No. CountY /���1
♦
OwneNOccupant Name Please Provide Two (2) Phone Pkrmber(s) Induding Area Code
JOCHUM LEO A ( � ( �
Power Supplier Power Suppli� Address
XCEL ENEROY
Cond�ector / Company Name Contractor License Number Master Electrician or Power Limited Tedmidan
HLiNT ELECTRiC Ct�RPORATION CA 00883 u`�"� ""`"�•
Mailing Address (Contractor, Campany w Owner Performing Installation)
2300 TERRRORIAL ROAD , SAIM' PAUL, MN 35114
AuUi�orized Signature (Contrador, Company or Owner Perfortning Insfalladon) Phone (s)
l��dYP�i� 861 648-2911
INS7RUCTONB ON BACK OF YELLOW COPY BOARD OF ELECTRICRY CAPV EB-0OOO1M14 8.7. 2fq2