P - 81720REQUEST FOR ELECTRICAL INSPECTION
' Minnesota Board of Electricity —
1. ��� V� 4 0 2 `P e� � 821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
� � ` (651) 642-OS00 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
IdentiTy the work covered by this request:
❑ NEW ❑ REMODEL � ADDITION ❑ REPAiR
GENERA! FEES
SERVICES / POWER SUPPLIES
0 to 400 Am ere �$25
401 to 800 Am re �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am re �$5 -
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S stem Device or A aratus �$.50
ADDITIONS TO THE GENERAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofd �$25 r Fixture
Center Pivot Irri aGon Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � $5
S arate Bondin In ion �$20
S ial Ins ection �$30 er Hour
Soecial Insoection � $.31 oer Mik
Traffic Signal Standard � $5
Supplemental Fee � $20
Transformers up to 70 KVA 4
Transformers over 10 KVA �
� Transformer I Power Supply for Signs ! OuUine Lighting �$5
ONE & 1W0 FAMILY DWELLtNGS, EACH UNIT
Includes the Service andlor Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$8L
Additional Inspection Trips � $20
lnvestiaative Fee
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FOR OFFlCE USE ONLY
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I certity that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at
Job Address (Street, Box, or Route No.) Ciry Z'
5821 Arthur St. NE Fridley �°�+32
Section Township Range Fire No. County
Hennepoin
Occupant Phone
Don Moore
Power Supplier ,p��
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Electrical CoMractor / Company Name CoMractor �icense Number Master License Number
Bassing Electric, Inc. CA00237
Mailing Address (Contractor, Company or Owner Performirtg Insfallation)
1354 McKay Drive NE, Ham lake, MN 55304
Authorized S' ature (Contractor, any or Owner PeAorming Installatlan) Pnone � 6 3- 4 3 4- 3 2 9 8
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EB-00001 A-13 7/1l2p00 � BOARD OF ELECTRICRY COPY INSTNUC710N8 d1 BACK OF YELLOW COPY