P - 79182' REQUEST FOR ELECTRICAL INSPECTION
' � � f � � � - 9 8 3 �0 Minnesota Board of Electricity � �:
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
° (651) 642-0800 TTY/MRS 1-800-627-3529 www.e[ectricity.state.mn.us
NEW 0 REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - ihe work covered by this request:
XCEL ENERGY SAVER'S SWITGN
iMMUNICATION, REMOTE CONTROL,
CIRCUITS OF LESS THAN 50 VOLTS
AILY DWELLINGS (PE
2 Units @ $50 Per Unit
Addi6onal Unit @ $25
Fixture
I�li ii lll II � II III Il l� �lii il l!! !I �I 11 �1 I�II
L 7 5 7 9 8 3 0
i
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Tvro Inspection Trips Each Dwelling Unit @$80
Reins tion Fee $20
TOTALFEE
(minimum total fee is $20) 20•SO
� iHISARFAFdtINSPECiORUSEONLr
I hereby certiy that I inspecled the electrkal installation described herein on Me dates stated:
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Kequest Date: Rough�n Inspection Required? lJ Yes L'J'NO Inspecdon Other Than Rough-In: L7Tteady Now C] VYdI Ca�l
�i�i �Q� You musl call the inspector when ready! Date Ready:
I certi(y that I am the S LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the elecfical work at:
Job Site Address (Street, Box, w Route No.) Ciry Zip Code
660� W BAVARWV PAS FRIDLEY 6643Z
Section Township Range Fire No. County
�0�
OwneNOaupant Name � r Please Provide Two (2) Phone Number(s) InGuding Nea Code
WELSH JUDfTH K � :,��, "� • ( ) ( )
r Supplier Prnnrer Supplier Address
XGEL ENEROY
ConVactor / Company Name Contractor License Number Master Elechidan or Power Limited Tednician
HUNT ELECTRIC CORPORATION CA OOB88 ucense Number
Mailing Add2ss (Contractor, Company or Owner Performing Installation)
2300 TERRfTOR1AL ROAD , SAINT PAUL, MN 55114
Authorized Signalure (Contractor, Company or Owner Performing Installffiion) Phme (s)
�(C�� 661 B46-�911
INBTRUGTION3 ON BACK OF VELLOW COPV BOARD OF ELECTRICITV CAPV EB-00007M14 8.7. 2W2