P - 80050REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity �
1-396-� �� � 1821 University Avenue Suite S-128, SaiM Paui, Minnesota 55104 -
(651) 642-0800 TTY/MRS 1-800-627-3529
www. electricity. state. mn. us
Identify the work covered by this request:
O�EW ❑ REMODEL ❑ AQ�ITION ❑ REPAIR
to
IALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS. CIRCUITS OF LESS TNAN 50 VOLTS
Y DWELLINGS
HOUf
Outdoor Liahtinp Standard �
Transfortners u to 10 KVA �$10
Transformers over 10 KVA � $20
Transfortners / Power Supply for Signs / Outline Lighting �$!
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Supply �p to 500 Amperes, All
Circufts and Two Inspection Trips Each Dwelling Unit �$80
Additional Inspection Trips � $20
FOq �NSPECTOH USE ONLY
I hefeby certify tAet
ROUGH IN
FINFL MSPECTIaJ
�
TOTAL FEE
total fee is $20)
DATE
DATE
��� � C�
POR OFFICE USE ONLY
Iflilil�lil�ilfllilliliillil�llllil��ll�l �� �
*13961016* � �6��
RequesiQ8t��2 Rough-in Inspeotion Required? ❑ Yes �No Inspection Other Than Rough-in: QReady Now ❑ WiA Call
U�r� X
You must call the inspector when ready! Date Ready:
I certify 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 Zip Cade
7573 4TH ST NE FRIDLEY 55�
Section Township Range Fire No. County AN�a
r, .
Occupant Phone
JC�dES JEAN D
Power Supplier Address
%CEL F:+IERCaY
Electrical ContreCtor / Company Name Contractor License Number Master License Number
HUNT ELEGTRIC OORPORATION CA 00883
Mailing Address (Contractor, Company or Owner PeAorming Installation)
� TERRITOftIAL Fi�AD , SAINT PAt�, MM 55114
Authorized Signature (Contractor, Company or Owner Perfortning Installation) Phone
�wel6.�e�ill�w� 651 F4&2�11
EB-OOOOtA-13 7/t/2000 BOARD OF ELECTRIGITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY