P - 80053REQUEST FOR ELECTRICAL II�SPECTION
Minnesota Board of Eleciricity
, 1-396-104 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-500-627-3529
www.electricity.state.mn.us '
Identify the work covered by this request:
❑�IEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
�
0 to 200 Am ere (� $5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htln Retrofit �$25 er FiMUre
CeMer Pivot Irriaation Boom � �40
7
XCEL ENERQY SAVER'S SWITC�i
Transtortners u to 10 KVA �$10
Transfortners overl0 KVA � $20
Transfortners I Power Supply for Signs / Outline Lighting �$5
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 �$80
Additional Inspection Trips � $20
Investi ative Fee
Reinspection Fee � $20
TOTAL FEE
(minimum total fee is $20)
FOR INSPECTOF IISE ONLY
i nereoy certny m,
ROUGH IN
FINAL INSPECTION
me
DATE
�^9 DATE
/ � z —5 ' ��_
T_�QMP_�ETED�YIIHIN 18 MONTHS _
FOR OFFICE USE ONLY
I IIIIII IIIII ��I IIIII Ilhl IHII illll IIIiI Iln I�I � S 9
* 1 3961 040* � ��56
Request�ate_�,� Rough-in InspecNon Required? ❑ Yes GLNo Inspection Other Than Rough-in: [�Ready Now ❑ Will Call
iJtitl O 7C n
You must call the inspector when readyl Date Ready: �
I certiiy that I am the � LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address Street, Box, or Route No. City Zip Cade
�7B� 4TH ST N� FRIdLEY 55432
Section Township Range Fire No. Counry A��a
occ� BAkJNE ROBERT D � I��. t- Phone
Power Supplier Address
� �Y
Electrical Contractor / Company Name Contractor License Number Master License Number
HUNT ELEGTRIC U4RPORATION CA 00883
Mailing Address Contractor, Company or Owner Performin Installation)
2�00 �TC�FtIAL ROAD , SAIN�PAUI., MN 5.'S114
Authorized Si natUre (C�rector,�Company,or Owner Perfortning Installation) Phone
6�1 �46-2919
EB-00001A-13 7/1/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY