P - 80452� REQUEST FOR ELECTRICAL INSPECTION
Minnesota Board of Electricity "�
1-381-443 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104 - ,
(651) 642-OS00 TTY/MRS 1-800-627-3529
www. electricity. state.mn. us
Identify the work covered by this request:
❑�tlEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
401 to 800 Ampere �
Above S00 Amoere �
�ALARM, COMMUNICATION, REMOTE CONTROL
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS
Each Svstem Device or A�oaratus �$.50
Each Additional Unit 8 $25
OTHER ADDITIONAL FEES
?(GEL ENERGY SAVER'S �WITGH
Outdoor Liahtino Standard � $t
to 10
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwelling Unit �$80
Additional Insoection Trios � $20
TOTAL FEE
total fee is $201
Recreational Vehicle Park SRes �$5 ROUGH IN �ATE
Se rate Bondin Ins 'on � $20
S eCial �n 'on �$30 per Hour FINAL INSPECTION oa�
S ecial Ins ection �$.31 r Mile — �- Y Q"'�'
,_THIS INSTALLATION MAY BE ORDERED DISCONNECTED I � COMPLETED WITHIN 18 MONTHS, �._
FOR OFFICE USE ONLY
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* 1 381 4439* �T���/
Requesl Date: Rough-in Inspection Required? ❑Yes ❑ Inspection Other Than Rough-in: eady Now ❑ Will Call
Q�%��� You must cell the inspector when ready! Date Ready:
1 certity that I am the [7 LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspecfion of the electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
2� 87rH WAY NE FRiDLEY 55432
Section Township Range Fire No. County
� � j ANC�MtA
Occupant Phone
YAhK3 YOUA
Power Supplier Address
Electrical Contractor / Company Name Contractor License Number Master Lice�se Number
HUIdT ELECTRIG CORPORATION CA 00�83
Mailing Address (Contractor, Company or Owner Performing Installation)
2�00 TERR{TORIAL R�AD , SAtNT PAUL, MN 56194
Authorized Signature (Contractor, Company or Owner Performing Installation) Phone
EB-OOOOtA-13 7/t/2000 BOARD OF ELECTRICITY COPY INSTRUCTIONS ON BACK OF YELLOW COPY