P - 81652REQUEST FOR ELECTRICAL INSPECTION
� Minnesota Board of Electricity —'�
���� V- 3 7 6 "� E �521 University Avenue Suite S-128, Saint Paul, Minnesota 55104
��e (651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identify the work covered by this request:
❑NEW �AEMODEL ❑ADDITION ❑REPAIR
0 to 400 Ampere � $25 �
401 to 800 Ampere � $50
Above 800 Ampere � $75
�UITS / FEEDERS
0 to 200 Ampere � $5 (,
Above 200 Ampere � $10
RM, COMMUNICATION, REMOTE CONTROL, SIGNALING
�UITS, CIRCUITS OF LESS THAN 50 VOLTS
Each System Device or Apparatus �$.50
ADDITIONS TO THE GENERAL FEES
Unit �
I Retrofit � $25 per Fixture
Pivot Irrigation 800m � $4(
ctured Home Park Lots � $
Gonal Vehicle Park Sites �
Outdoor Li htin Standard � $1
Traffic Siqnal Standard � $5
Su demental Fee � $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transformer / Power Su I for Si ns I Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service and/or Power Suppty up to 500 Amperes, All
Circufts and Two Inspection Trips Each Dweliin Unit �$8(
Additional insoection Trips � $20
I herebvi certiN that I
m total fee is $20) QO, �
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described herein on the �tes stated:
/ onre
Se rate Bondin Ins ection �$20 � ^G�"�
S ial Ins ion �$30 er Hour ""'L "�0"0N °A
S'al In ion �$.31 r Mile ���7-0�
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18
FOR OFF�E USE ONLY
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Request Date: Rough-in Inspection Required? Yes ❑ No Inspecdon Otl�er Than Rough-In: ❑ Ready Na
1-1 2— O 1 vou must can me �nspector wrren ready� Date Ready:
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I certi(y that 1 am the ,�LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (Street, Box, or Route No.) Ciry Zip Code
1170 52nd Fridley
Section Township Range Fire No. County
Hennepin
OccupaM Phone
KJ Management
Powe� Supplier Address
NSP 3I15 Center Point Drive, Roseville
Electrfcal Conhactor / Company Name Contractor License Number Master License Number
Bassing Electric, inc. CA00237
Mailing Address (Contractor, Company or Owner Pertorcning Installation)
1354 McKayDRive NE, Ham Lak�, MN 55304
Authorized Si nature (CoM��ny or Owner Pertorming Installation) Phone — —
76
EB-0OOO1M13 7/1/2000 . BOARD OF ELECTRICfTY COPY INSTRUCTIONg ON BACK OF YELi-OM����