P - 79257'� REQUEST FOR ELECTRICALINSPECTION E
Minnesota Board of Electriciry
1-396-191 � 1821 Universiry Avenue Suite S�128, Saint Paul, Minnesota 55104
(651) 642-0800 TTYIMRS 1-800-6273529
www.electricity.state.mn.us -
IItlemity ihe work caveretl by this request.
O�NIEW ❑ REMODEL ❑ AD�ITION 7
I ALARM, COMIMUNICATION, REMOTE CONTROL,
IIIII 1IIII IIII I I IIII1IIII I I1II I� III
XCEL ENEROY SAVER'S SWITCH
OuMoor li In Standerd � $1
TraHic Si nal Standard � 55
Su: lemental Fee � $20
Transfortners u io 10 KVA �$f 0
Transiortners overl0 KVA B $20
Transiortners / Power Su I tor Si ns i Outline Li htin �$5
ONE 8 TWO FAMILV DWELLINGS, EACH UNIT
IncWtles Ihe Service anNOr Power Supply up to 5�0 Amperes, All
Circuits and Two Inspection Tnps Each Dwelling Unit �$80
Addifional Inspection Tnps � £2�
. Investl INe Fee
Relns actlon Fee � $20
TOTALFEE
(minimum total fee is $20)
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FIN1LiN8GEClION ��
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FOP OFFICE USE ONLY
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I � V°u musl call ihe inspactor wnen reatlyl I Oa�e Featly: I
I cerlify ihat I am the Q4 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspeclion of the electrical work at:
�d, nedreuis��t. eox1NE�� G� NE � ty FRI�LEY z�v cme 55432
Seclion Township Range Fire No. Counry AN�iA
o�c�P��IN JUDITH A li Pn��e
PcwerSupplie* Ad�ress
XCELENERGY
ElecMCal Con[2clor / Com an Name ConVac[or License Num�er Master License Number
HUNT ELEC�R�G CARPOR4TI4N GA 00883
M8i1ing �2300 �E��RRITORIAL ROAO �� SAImN19PAUL� MN 55� 14
Au�horizetl Si�(COn[rzcto� r,�COmp� r pwner Pedorming Instellatlan) P�one
651 648-2911
FR-INIM1A-13 ]A/900(1 ROARfI OF FI FMRIf,ITV COPV INSTRUC.TIONS ON BACK OF VELLOW COPV