P - 81721REQUEST FOR ELECTRICAL INSPECTION
� Minnesota Board of Electricity
��. � V- 3 9 8 1821 Universiry Avenue Suite S-128, Saint Paul, Minnesota 55104
{651) 642-0800 TTY/MRS 1-800-6273529
i www.electriciry.state.mn.us `' '
ItlentiTy the work covered by this request:
❑NEW �REMODEL ❑ADDITION OREPAIR
GENERAL FEES Outdoor Li htin Standard (� $1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
j 0 to 400 Am ere �$25 Q Su lemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above S00 Am ere �$75 Transformers over 10 KVA �$20
CIRCUITS / FEEDERS Transformer / Power Su for Si ns I Outline ' htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwellin Und �$80
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Additional Ins ion Tri s�$20
Each S stem Device or ratus �$.50 Investi a6ve Fee
ADDITIONS TO THE GENERAL FEES ReinscecNon Fee �$20
Retrofit � $.25 oer Fixture
I hereW certifv ihat I
Inspection � $21
� $30 per Hour
� $.31 oer Mile
total fee is $20) QO, rA
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QO. Sa
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WITHIN 18 MONTHS
FOR OFFICE USE ONLY
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Request Date: Rough-in Inspection Requiretl? es ❑ No Inspection Ofher Than Rough-In: ❑ Ready Now �II Call
3-6-01
You must call the i�spector when ready! 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.) Cily �P �e
1050 52nd Ave. Fridley
Re� I Fire No. I Counry H e n n e p i n
p��p� Phone
KJ Management
Power Supplier g�ry�
Excel 2 S ZA.li18 Chestnut Ave . N. Mpls , 55403
Elecirical Contractor / Company Name Contractor License Number Master License Number
Bassing Electric, Inc. CA00237
Mailing Address (Contractor, Company or Owner PeAorming Installation)
1354 McKay Drive Ne,Ham Lake, MN 55304
Authorized ignatu �ctor, pany or ONmer PeAortning installation) Phone
763-434-3298
EB-OOOOtA-13 �/1/2000 BOARD OF ELECTRICITY COPY � INSTAUCTIOI� ON BACK Of YELLOW COPY