P - 80054' REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
1�396-103 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 -
(651) 642•0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
IdenYrfy the work covered by this request:
OTIiIEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
Above 800 Ampere �
� ALARM, COMMUNICATION, FiEMOTE CONTROL, SIGNALING
MULTIFAMILY DWELLINGS (PER UNI
3 to 12 Units �$50 Per Unit
Each AddiNonal Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 er FiMure
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � 5
Recreational Vehicle Park Sites
XCEL ENEROY SAVER'S SWlTCH
Transformers u to 10 KVA �$10
Transfortners overl0 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 TriDS Each Dwelling Unk �$80
USE ONLY
I hereby certity ihat I inspected the eleclrical
ROUGH IN
FINAL INSPECTION /
TOTAL FEE
total fee is $20)
DATE
DA7E
FOR OFFICE USE ONLY
IIIIII(IHII��I�UIIIiiI� �� ����
* 1 3 9 6 1 0 3 2* p10�-S�
RequeS,t 0a1Q:.�� Rough-in Inspection Required? ❑ Yes f.jNO Inspection Other Than Rough-in: G1Ready Now ❑ Will Call
ui3n � iti 7�
You must call the inspector when ready! Date Ready:
I certiiy that I am the !�j LICENSED CONTRACTOR O COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address�7t, Box,4TM ST N� City Fa'� Zip Code �3
Section Township Range Fire No. County a�a
Occupant Phone
Rf7EHUtE WALTER J
Power Supplier Address
icc��.. �Y
Electrical Contractor / Company Name Contractor License Number Master License Number
HUNT ELEGTRIC 04RPORATt4N CA 00883
Mailing Address (Contractor, Company or Owner Pertorming Installation)
2300 TEARITdF21AL ROAO , SAINT PAUL, MN 55114
Authorized Si nature (�recio r�Company,or Owner Perfortning Installation) Phone
651 846-2911
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY