P - 80038, ' REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity
� �-396-1 13 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-500-627-3529
www.electricity.state.mn.us ' �
Identify the work covered by this request:
LrREW ❑ REMODEL ❑ ADDITION ❑ REPAIR
0 to 400
401 to 8i
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTRQL, SIGNALING
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS (PER UNI
3 to 12 Units �$50 Per Unit
Retrofit � $25 per Fixture
HOUf
XCEL Eh1ERC3Y SAVER'S SWiTt�i
Outdoor Liahtina Standard � $t
ONE 8 TWO FAMILY DWELLINGS, EACH UNIT
Includes the Senrice and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspeclion Trips Each Dwelli�g Unit �$f
Addifional Insoection Trios � $20
ROUGHIN
FINAL INSI
Fee �
TOTAL FEE
d fee i5 $20)
I inspected the elecMrical installatlon described herein on the tletes slated:
DAiE
DATE
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� NOT__,__CQAI�ETEp�IJ(ITHIN 18 MO�yjHS
FOR OFFICE USE ONLY
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Reque�$��2 Rough-in Inspection Required? ❑ Yes C�No Inspection Other Than Rough-in: I�Ready Now ❑ Will Cell
You must call the inspector when ready! Date Ready:
1 ceRity that I am the L�S LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the eiectrical work at:
Job Address,�����, eoXQ�,k r�� � ary FR�� zP coae �
Section Township Range Fire No. County Ai�(A
Occupant Phone
LUHMAN JOHN D
Power Supplier ddr ss
iicE� �v
Electricel Contractor / Com n Name ConVactor License Number Master L'u:ensa Number
HUNT ELEC'�R�C CORP4RATION CA 00983
Mailing �r ��, c��y�r ow�er�PbgAll � PA���MN 55114
Authoriz nature (�ractor, ompany or Owner Performing Installation) � Phone
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EB-00001A-13 7l112000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF VELLOW COPY