P - 79557REQUEST FOR ELECTRICAL INSPECTION
1� 214 - 9 3 7 g tl Minnesota Board of Electricity
1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
(651) 642-0800 TTY/MRS 1-800-627-3529
www.electricity.state.mn.us
Identity the work covered by this request:
❑NEW ❑REMODEL ❑ADDITION
0 to 400 Am ere �$25
401 to 800 Am ere �$50
Above 800 Am ere � $75
CIRCUITS / FEEDERS
0 to 200 Am ere (� $5
Above 200 Am ere � $10
ALARM, COMMUNICATION, REMOTE CONTROL, SIG
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS
Each S iem Device or A aratus (� $.50
ADDITIONS TO THE GENEFiAL FEES
MULTIFAMILY DWELLINGS PER UNI
3 to 12 Units �$50 Per Unit
Each Additional Unit � $25
OTHER ADDITIONAL FEES
Li htin Retrofit �$25 r Fixture
Center Pivot Irri ation Boom �$40
Manufactured Home Park Lots � $25
Recreational Vehicle Park Sites � � � _
/ �l i��;� O�i/"v%.�I� 7� /�.%'�
Outdoor Liahtina Standard � $1
Traffic Si nal Standard � $5
Su demental Fee c� $20
Transformers u to 10 KVA �$10
Transformers over 10 KVA � $20
Transiormer / Power Su I for Si ns / Outline Li htin �$5
ONE & TWO FAMILY DWELLINGS, EACH UNIT
Includes ihe Service and/or Power Supply up to 500 Amperes, All
Circuits and Two Inspection Trips Each Dwellin Unit �$80
Additional Inspection Trips � $20
InvestiaaGve Fee
�ecial Inspection �$.31 per Mile � �
'HIS INSTALLATION MAY BE ORDERED DISCONNECTE
FOR OFFlCE USE ONLY
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III1i I�I�i Illfl Illll IIIII Eilli IIIII IIIII I�i1�111
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total fee is $20) �=�
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that I insoected ll�e electrical installation described
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I certity that I am the �LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspectiai of the electrical wak at:
Job Address (Street, Box, or Rou[e No.) City Zip Code
7650 Arthur �t. TIE Fridley 55432
Sec[ion Township Range Fire No. County A jl O�t a
o����t A�� �� Phone � 6 3- 2 41- 8 4 2 9
Jerry Wedebrin J � �
Power Supplier Address
XC21
ElecVical CoMractor / Company Name Conhactor License Number Master License Number
Bassing Electric, Inc. CA00237
Mailin Address (Contrec[or, Company or Owner Performing Installation)
13.�4 McKay Dr. NE, Ham Lake, Mid `>'�:;�;)�;
nutnorized si r$ ( ra J m ner Pe �nsta��ation) Pf'�'e� —(F 3[+ — 3 2 9 H
EB-00001A-13 7/1/2000 BOARD OF ELECTHICPrY COPV � INSTpUC'110NS ON BACK OF YELLOW COPY