P - 80172� REQUEST FOR ELEC7RICAL INSPECTION
� Minnesota Board of Electricity
1-396-163 C? 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www. electriciry. sta te. mn. us
Identiiy the work covered by this request:
�QEW ❑ REMODEL ❑ ADDITION ❑ REPAIR XCEL ENEROY SAVER'S SWIT�FI
GENERAL FEES Outdoor Liahtina Standard �$1
0 to 4D0
401 to 8i
Above 8i
:UITS / F
0
� ALARM,
REMOTE CONTROL, SIGNALING
SS THAN 50 VOLTS
3 ta 12 Units (�1 $50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Liphtina Retrofit � $25 per Fi�ure
Park Sites (�
7
Transformers over 10 KVA � $20
Transfortners / Power Supply for Signs / Outline Lighting �
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$£
Additional Insoection Tri�s � $20
ROUGH IN
r � �� ;
, l�:
,. �:;..,....:
OTAL FEE
fee is $20}
I inspectetl Me eiectricel ihslallafbn tlescribed herein on tlre dates steted:
DATE
DATE
c � 6 --�
_NOT COMPLETEQ VYITHIN i8 MoNTHS __
FOR OFflCE USE ONLY
III�IIIIIIII����IIIIIIII������
* 1 3 9 6 1 6 3 6* �� �o • S�
Request Date: Rough-in Inspection Required? ❑ Yes ❑ No Inspection Other Than Rough-in: ❑ Ready Now ❑ Will Call
�8�1 �i2 You must call the inspecTOr when ready! x Date Ready: x
I certiiy that I am the C� LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) City Zp Cot1e
871 M40RE LAKE DR W FRtDLEY 55�132
Section Township Range Fire No. Cou^ty AP�A
Occupant Phone
oa� ToM �
Power Supplier Address
� ��Y
Electrical Contractor / Company Name Contractor License Number Master License Number
HUNT ELECTRIC CORPrJRATION GA 00863
Mailing Address (ConVactor, Company or Owner Psrtorming Installation)
2300 TEI�ITdR1AL 12f�A0 , SAIAIT PAt�, MN 55114
Auttrorized Signature (Contractor, Company or Ow�r Perfortning Installation) Phone
651 64�-2911
EB-00001 A-13 7/1/2000 BOARD OF ELECTRICITY COPV INSTRUCTIONS ON BACK OF YELLOW COPY