P - 80156r REQUEST FOR ELECTRICAL INSPECTION
PAinnesota Board of Electriciiy
, 1-391-353 � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TfY/MRS 1-800-627-3529
www.electricity.state.mn.us p-S ' �
IdentiTy the work covered by this request: �•
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❑ NEW ❑ REMODEL ❑ ADDITION ❑ REPAIR
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su lemental Fee �$20
401 to 800 Am ere �$50 Transfortners u to 10 KVA �$10
Above 800 Am ere �$75 Transfortners over 10 KVA �$20
CIRCUITS / FEEDERS Transformers / Power Su I for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am ere �$10 Includes the Service andlor Power Suppty up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Inspection Trips Each Dwelling Unit �$80
CIRCUITS. CIRCUITS OF LESS THAN 50 VOLTS Additlonal Inspection Trips �$20
Each S stem Device or Apparatus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reinspection Fee �$20
MULTIFAMILY DWELIINGS (PER UNI� TOTAL FEE �
3 to 72 Units �$50 Per Unit (minimum total fee is $20
Ear.h AddiTional llnit @ R7F Fa+iNSPecra+useow�v
Lighfing Retro�t � $
Center Pivot Irrigatio
Manufactured Hane
Recreatlonal Vehicle
ROUGH IN
�IRRCINSPECTION
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me deres stated:
DATE
DATE
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� �� ruH OFFICE USE ONLY
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i * 1 391 3538* �a"a��s-�
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Heq�@sL�t�.2 Rough-in Inspection Required? ❑Yes o Inspection Other Than Rough-in: Ready Now ❑ Will Call
ZS-1 'U 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 Code
1621 76� AVE NE FRIDLEY
Section Township Range Fire No. County
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OccupaM � Phone
AMTI'I'Y CASTIMICH 'a • 763-742-4483
Power Supplier Address
N/A X
Electrical Contractor / Company Name Contractor License Number Master License Number
KOVAR ELECTRIC LLC CA03644
Mailing Address (Contractor, Company or Owner Performing Installation)
a�9 Axxowx�w sr rtw sr r�xcis �r sso�o
Authori�ature Contrecfor, Company o� Aorming Installation) Phone
763-733-5731
EB-OOOOtA-13 7/t/2000 BOARD OF ELECTRIGTY COPY INSTRUCTIONS ON BACK nF YEi t OW CoaV