P - 79347❑ REQUEST FOR ELECTRICAL INSPECTION
�� 1 I�— 616 � 8121 Unrvte By Ave � eESu 1erS- 28, Saint Paul, Minnesota 5510A
� (651) 642-0800 TfYlMRS 1-800-627-3529 www.electricrty.state.mn.us
NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR Describe -using the back of the white copy if necessary - the work covered by this request:
XCE� ENERGY SAVER'S SWITCH
ALARM, COMMUNICATION, REMOTE CONTROL, SIGi
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus @$.50
ADDITIONS TO THE GENERAL FEES
Each Addifional Unit
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit @$80
(minimum total fee is $20) � $20.50
TNIS ARFA FOR INSPECiOR USE OnYY
I hereby certty that I inspec0ed the elecOrical installatian described herein on tlie da�s stated:
l� ��• �y
�� �
I I�� 8�� 11IN 11 �I !I �l II�II II III Il�I ll lll l llll
���/
17736�1��
� ,�
Request Date: Rough�n Inspection RequiredT ❑ Yes Inspedion Other Than Rough-In: Q ady Now � Will Ca
�9/"��� You must call the inspector when ready! Date Ready:
1 certiiy Uiat I am the CDCICENSED CONTRACTOR ❑ COMPANY � OWNER and hereby request inspection of the etectrical wc
Job Site Address ( reet, Box, or Route No.) City Zip Code
5854 W BAVARIAN PAS FRIDLEY 55432
���E� �o� � 3 � -�� � _ c �
Power Supplier Power Supplier Address
XGEL ENERGY
Conhactor / Company Name Contracta License Num
HUfdT ELECTRIC CORPORATION CA 00688
Mailing Address (Contractor, Canp�y or Owner Pe�formi�g InslaUatiort)
2300 TERRf7dRiAL RdAD , SAINT PAUL, MN 55114
Authorized Signature (Contractor, Company or Owner Perfortning Installatlon)
��
INSTRUCTIONB ON BACK OF YELLOW COPY BOARD OF ELECTRICITV COPY
Ahl4KA
c�
Master PJeClndan or
License I�mber
s�� r�s-as� � �
EB-00001M14 8.1. Z002